Poisoning and Mucosal Burning by Laundry Detergent Capsules: A Case Report

Background: One of the main sources of poisoning in young children are cleaning products. Among the newest ones, we find laundry detergent capsules (LDC). Because their higher concentration of detergent serious clinical manifestation can be observed.

We present a case of a 12-month-old boy who bit an LDC (Ariel 3in1), and developed metabolic acidosis, digestive and respiratory impairment.

Case Presentation: A healthy 12-month-old boy, was brought to Emergency Room vomiting, coughing and dysphonia after biting an LDC. We contacted the National Institute of Toxicology of Spain who told us the main risk of this ingestion is metabolic acidosis, but not chemical mucosal burning. In the physical examination he was irritable with presence of respiratory distress and inspiratory stridor. Laboratory tests on admission revealed: Hemoglobin: 11.4g/dL, WBC 29400/μL (neutrophils 57%). The blood gases showed a metabolic acidosis (pH 7.29, HCO3: 15mmol/L, pCO2: 40mmHg, BE: -13mmol/L). Renal function was normal. A chest X-ray revealed bilateral peribronchial thickening, predominantly at the left base. He was initially treated with dexamethasone, nebulized adrenaline, salbutamol, oxygen and bicarbonate perfusion, which was maintained for 3 days. On the second day, an upper endoscopy showed caustic ulcerations in epiglottis and subglottic regions. Esophageal endoscopy did not show any damage. Hemoglobin gradually dropped to 8g/L at 3^rd day. Digestive hemorrhage was suspected and treated with omeprazole.

At discharge respiratory symptoms and metabolic acidosis were solved with no digestive symptoms. Three months after an upper gastrointestinal series showed a membrane in the middle third of the esophagus.

Conclusions: The main component of the Ariel 3in1 is Dodecylbenzenesulfonte which may produce gastrointestinal burning. However, combining it with other component, Propylene-gycol, the toxicity may enhance, and appear metabolic acidosis. When bitten by children can burst and spray the content in the respiratory and GI systems, causing mucosal damage leading to several complications.