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Poisoning in children 4: Household products, plants, and mushrooms
  1. M Riordan1,
  2. G Rylance2,
  3. K Berry3
  1. 1Department of Pediatrics, Yale University Medical School, USA
  2. 2Department of General Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  3. 3Accident and Emergency Department, Birmingham Children’s Hospital, Birmingham, UK
  1. Correspondence to:
    Dr K Berry, Accident and Emergency Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK;
    kathleen.berry{at}bhamchildrens.wmids.nhs.uk

https://doi.org/10.1136/adc.87.5.403

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    Management of children who have ingested bleach, white spirit, turpentine, general household cleaning products, alcohol, rodenticides, petrochemicals, essential oils, vapour treatments, nail care products, and washing powder; and also poisonous plants, berries, or mushrooms

    In this, the fourth of a series of articles on the management of poisoning, we deal with poisoning caused by the ingestion of household products.

    BLEACH

    Household solutions contain approximately 10% sodium hypochlorite. They are rarely ingested in significant quantity, as they are extremely unpalatable. Commonly encountered effects include nausea, vomiting, and diarrhoea.

    Less than 100 ml of household bleach is unlikely to cause serious problems.1 Fluids should be encouraged, particularly milk.

    Oesophageal damage occurs rarely and is associated with concentrated solutions (industrial bleach may contain up to 50% sodium hypochlorite) or the ingestion of large volumes. Patients at risk of oesophageal damage require hospital admission and careful attention to fluid and electrolyte balance. Early endoscopic examination with gastric aspiration may be considered. Expert advice should be sought.

    TURPENTINE, WHITE SPIRIT, AND TURPENTINE SUBSTITUTE

    Turpentine oil has been largely replaced with white spirit and turpentine substitute.

    White spirit and turpentine substitute are of relatively low toxicity when ingested. Gastrointestinal irritation is commonly seen. Central nervous system depression may occur if large quantities are ingested. Their main toxicity relates to the risk of aspiration resulting in a chemical pneumonitis. For this reason gastric decontamination is contraindicated.

    All patients should be assessed for signs of respiratory distress. This includes measuring oxygen saturation, recording respiratory rate, and auscultating the chest for additional sounds. The majority of cases are asymptomatic and patients do not necessarily require observation.2 Careful administration of oral fluids is required and advice must be given to return if children develop cough or fast, noisy, breathing. Children can develop symptoms up to 24 hours post-ingestion.

    Children with symptoms suggestive of pneumonitis require …

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