3. Toxins in the Home RYAN

Under Kitchen Sink:

  • Liquid Dish Soaps

  • Detergents

    • Anionic, Nonionic

    • Cleaners may have cationic detergents

  • Automatic Dishwasher Detergents

    • Enzyme detergents, builders

  • Dilution is the solution to pollution!

  • Vomiting, diarrhea – self limited

  • Furniture Polishes

    • Hydrocarbons

    • Aspiration concern

    • Dilute. No emesis

  • Drain cleaners

    • Corrosive

    • Liquefactive necrosis

    • Dilute

    • Irrigate x 30 minutes

    • Break blisters

  • Roach Bait

    • Boric Acid

    • Nausea and Vomiting

    • Blue Green Color

    • “Boiled Lobster” syndrome

    • Dilute & observe

  • Oven Cleaners

    • NaOH most common

    • Dilute/Flush and observe

  • Rodenticides

    • Warfarin/Superwarfarin

    • Affect Vitamin K dependent clotting factors

    • No effects typically for 2-3 days after exposure

    • Typical concentration of 0.005%

    • Handful amount of pellets in a child should not cause effects.

    • Observe for bleeding signs

    • Treat with Vitamin K1

    • Treatment may be required for weeks

  • Ammonia

    • Odor detectable at 1.3 to 1.75 ppm

    • 5-10% concentration typical

    • Reacts with water to produce NH4OH

    • From irritation to burns depending on concentration

    • Dilute/irrigate.. Observe

  • Mothballs

    • Napthalene

      • 1 mothball can cause toxicity

      • Can cause hemolysis

        • G6-PD deficiency a concern

        • Dilute/irrigate & observe

  • Paradichlorobenzene

    • Most common ingredient today

    • Mainly an irritant

    • Dilute/irrigate & observe

In the Laundry Room

  • Laundry detergents

    • Anionic and nonionic detergents typical

    • Self limiting vomiting and diarrhea

    • Dilute & observe

  • “New” Pod Detergents

    • Much more concentrated

    • Protracted vomiting

    • Respiratory distress

  • Liquid Bleach

    • 3-10% Sodium Hypochlorite

    • Small ingestions typically cause N,V, irritation

    • Dilute/irrigate & observe

    • Self limiting vomiting

  • “New” Concentrated Bleach

    • 12-15%

    • Mucous membrane irritation

In the Bathroom:

  • Toilet Bowl Cleaners

    • Many contain acids

    • Dilute/irrigate

    • Do not neutralize

  • Shower/Tub/Tile Products

    • Detergents

    • Hypochlorites

    • Mixing hypochlorite containing products with acids results in chlorine production

    • Dilute/irrigate

  • Nail products

    • Cyanoacrylates (super glue)

    • Dry extremely fast

    • Do not attempt to pry/peel to free

    • Warm water soak

    • Damage from attempts to remove

  • Cold sore products

    • Campho Phenique

    • Camphor

    • Seizure concern

    • 2 tsp could be fatal in a child

  • Rust Removers

    • Contain HF

    • Decreases Ca and Mg

    • Often no visible effect

    • Intense Pain

    • Pain often delayed 6-10 hours

    • Treat with Dermal, IV, or IA calcium

    • Ca gel, Ca gluconate preferable

  • Mouthwash

    • Typically ~25-30% ethanol

    • Observe for signs of intoxication

  • Cologne/Perfume

    • Some > 98% ethanol

  • Toilet Bowl cleaners

    • Acid

    • Do NOT mix with other cleaners

  • Oragel

    • Benzocaine

      • Cause methemoglobinemia

      • Cyanosis with level > 8-10% methem

      • Life threatening >30-40% methem

      • Signs and Symptoms

        • Cyanosis

        • Lightheaded

        • Tachycardia

    • Treated with methylene blue

    • 30% give MB

    • 1 to 2 mg/kg

    • Methem levels fall rapidly

    • Avoid overdosing

Outside

  • Automotive Products

    • Antifreeze

      • Ethylene Glycol

      • Inebriation

      • Co ethanol ingestion a concern

      • Decreased calcium

      • Possibly oxalate crystals in urine, urine may fluoresce

    • Treatment

      • Fomepizole

    • Washer fluids

      • Methanol

        • Summer and Winter formulas

      • Inebriation, profound acidosis, increased osmol gap

      • Snow field blindness

        • Formic acid metabolite

      • Treated with fomepizole, dialysis if severe

        • Treatment can be stopped when level < 20mg/dl

    • Wire Wheel Cleaners

      • ammonium bifluoride

        • Calcium

      • Hydrocarbons

        • motor oil, gasoline

        • Dilute and observe

        • Aspiration symptoms usually occur in first few hours

        • Cough, SOB

        • CXR, sx usually resolve in 24 hours

  • Gopher Bait

    • Strychnine

      • Muscle spasms trismus, risus sardonicus

      • Spasms get worse with stimulus

        • Eventual opisthotonus

      • Lactic acidosis, rhabdomyolysis

      • Death from asphyxiation

        • No antidote, keep in quiet dark room

        • AC if ingested

        • Control convulsions and muscle relaxant

    • zinc phosphide ( Zn2P3)

      • releases phosphine gas

      • Rotten egg odor

      • Signs and Symptoms

        • Pulmonary edema

        • Nausea, abdominal pain

        • Liver necrosis

        • Kidney necrosis

        • Mucosal hemorrhage

  • Paint strippers

    • methylene chloride

    • Metabolized to CO

    • HA, N, drowsy, confused

    • Treatment

      • Oxygen

      • Fresh air

      • 100% O2 Non- rebreather mask

      • Hyperbaric

  • Pool Chlorine

    • Ca or Na Hypochlorite

    • Strong irritant

    • Fresh air

    • To HCF if sx persist