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Case of Dettol and Bleach poisoning

Case of Dettol and Bleach poisoning. Dr. Wong Oi Fung AED of TMH. History. Mr. Chow; 32/M Good past health; NKDA Brought to AED of TMH at 08:06 on 5/4/2004 Drank ~ 1 liter of Dettol solution mixed with bleach solution in a suicidal attempt Also taken 2 tablets of pain-killer

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Case of Dettol and Bleach poisoning

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  1. Case of Dettol and Bleach poisoning Dr. Wong Oi Fung AED of TMH

  2. History • Mr. Chow; 32/M • Good past health; NKDA • Brought to AED of TMH at 08:06 on 5/4/2004 • Drank ~ 1 liter of Dettol solution mixed with bleach solution in a suicidal attempt • Also taken 2 tablets of pain-killer • Drank large amount of water before arrival • Vomiting several times with clear fluid

  3. Vital signs • BP 133/89 • Pulse 83 bpm • Temp. 36C • SpO2 93% on O2 • GCS 15/15 • Category 2

  4. Physical examination • Alert and conscious • No stridor • Edematous change over soft palate • Surgical emphysema over neck • Crepitation over bilateral chest • Abdomen soft • No focal neurological signs • Superficial cut wound over left wrist; no tendon injury

  5. Investigation • Spot blood glucose 6.1 • istat: pH 7.32, HCO3 16.7 • ECG SR no ST change • CXR showed generalized hazziness over bilateral chest; mediastinal gas • X-ray of lateral neck showed no obvious soft tissue swelling; retropharyngeal gas

  6. Progress • ICU consulted • Prophylactic antibiotic ( augmentin and flagyl ) • Poor prognosis explained to relative • Admit to ICU ward

  7. Progress • on supportive treatment • Developed acute renal failure on hemodialysis support • pneumomediastinum and surgical emphysema gradually resolved • Barium meal esophageal ulcer with no leakage • Pyschiatrist consulted paranoid schizophrenia; started haloperidol

  8. Progress • Renal function gradually improved • Creatinine up to 1300 mmol/L ~ 1 week after admission • Cr ~100 mmol/L ~6 week

  9. Progress • Readmitted on 1/6/2004 for increasing dysphagia x few days • Not tolerate solid or liquid • OGD  corrosive esophageal stricture at 26 cm from incisor • Readmitted on 8/6/2004 for OGD and dilatation • FU surgical unit

  10. Dettol posioning • Dettol • Widely used as an antiseptic and disinfectant • Mixture of 4.8% chloroxylenol, pine oil and isopropyl alcohol • Toxicity: • Respiratory: largngeal obstruction, upper airway edema (may be delay) and aspiration pneumonia • Neurology: CNS depression • GI: nausea, vomiting and abdominal pain • Renal: acute renal failure

  11. Dettol poisoning • Treatment • Supportive • Maintain airway patency and prevent aspiration • Dilution is controversial increased risk of vomiting and aspiration esp. in patient with altered level of consciousness.

  12. Bleach poisoning • Household bleach • ~5% sodium hypochlorite • Alkaline pH 10.0 to 12.0 • Exposure: ingestion, inhalation, dermal or eye • Toxicity: • GI: corrosive damage to upper GI tract( >5ml/Kg) • Respiratory: edema of glottis, pulmonary edema and pneumonitis • Metabolic: metabolic acidosis, hypernatremia and hyperchloremia • Skin: dermal irritation and hypersensitivity • Eye: Corneal injury

  13. Bleach Poisoning • Mechanism of toxicity for GI tract • 2NaCLO + H2O +CO2  Na2CO3 + 2HCLO • 2HCLO 2HCL + O2 corrosive injury • Inhalation injury • Mixed with other acidic toilet bowl cleaners or ammonia • NaCLO +HCL + H2O CL2 +2 NaOH • NACLO + NH3 NH2CL + Na + OH pneumonitis

  14. Bleach poisoning • Treatment: • ABC • induced emesis, gastric lavage NOT indicated • decontamination of skin and eye • ? Dilution with water and milk ( 120 to 240 ml) • Oxygen +/- ventilatory support • Bronchodilator for bronchospasm • Steroid for acute lung injury controversial • Endoscopy if symptoms (drooling, dysphagia or pain ) are present or large amount (> 5mg/kg) is ingested

  15. Treatment (continued) • Surgical emphysema from esophagus or airway? Or both? • No early or urgent OGD in this case due to ? poor respiratory status • Ba swallow several days post ingestion • Cautious early OGD + bronchoscopy preferable? + ET intubation beforehand • OGD findings guide any steroid & surgical therapy

  16. Thank you

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