Background
Laundry Detergent capsules (e.g. Liquitabs) are household domestic products usually packaged as small, brightly coloured concentrated detergent sachets. The majority of laundry detergent capsules contain a combination of agents, of which include, an anionic detergent (20-30%), a non ionic detergent, propylene glycol (15 – 20%), and ethanol (2 – 5%) and a cationic surfactant. These agents are dissolved in water to form an alkaline solution.
Most patients are < 5 years old and present with ingestion, eye contact or skin contact symptoms.
Serious oesophageal ulceration may occur.
Symptoms
- GI: Vomiting, nausea, dairrhoea and less comonly abdominal pain
- Airway: Coughing, Bronchospasm, Pharyngitis, stridor
- Chemical burn
Management
- Detailed Hx/Exam
- Beware symptoms above
- If epiglottic burn - call anaesthetics
- Mouth burns indicate a risk of imminent airway compromise
- If well but risk of airway burn/oedema:
- CXR and PFA
- Analgesia and supportive management
- Surgical assessment ± early endoscopy/ CT
- Give broad-spectrum antibiotics if proven perforation
- IV H2 antagonists or PPIs may reduce corrosive injury
- Activated charcoal is contraindicated
- Gastric lavage is not recommended
- Immediate lavage and ophthalmology referral if suspected (alkali) eye injury
Admission/observation
Involve anaesthetics (airway) or surgical(GI) with findings above.
GCS of 15, no obvious burns/symptoms
- Observe for 6 hours and monitor vitals
- ECG to assess QRS and QT intervals
- Repeat ECGs is patients are symptomatic
In patient with GCS of less than 15
- FBC, U&E, Coag and VBG
- 12 lead ECG
- Complete primary and secondary assessment
Links
- IAEM Clinical Guideline 8 - Laundry Detergent Capsule Guideline
- https://www.toxbase.org/
- http://www.rch.org.au/clinicalguide
- http://www.alsg.org/uk/APLS