Case of dettol and bleach poisoning
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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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Case of dettol and bleach poisoning

Case of Dettol and Bleach poisoning

Dr. Wong Oi Fung

AED of TMH


History

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


Vital signs

Vital signs

  • BP 133/89

  • Pulse 83 bpm

  • Temp. 36C

  • SpO2 93% on O2

  • GCS 15/15

  • Category 2


Physical examination

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


Investigation

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


Progress

Progress

  • ICU consulted

  • Prophylactic antibiotic ( augmentin and flagyl )

  • Poor prognosis explained to relative

  • Admit to ICU ward


Progress1

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


Progress2

Progress

  • Renal function gradually improved

  • Creatinine up to 1300 mmol/L ~ 1 week after admission

  • Cr ~100 mmol/L ~6 week


Progress3

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


Dettol posioning

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


Dettol poisoning

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.


Bleach poisoning

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


Bleach poisoning1

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


Bleach poisoning2

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


Treatment continued

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


Thank you

Thank you


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