Feb 19, 2018: What is the Tide Pod Challenge?

We have had many requests for information about tide pods.  There are two age groups that are exposed-the toddlers and the teenagers.  Unfortunately, bad things can happen to either group.  ds

The Devil’s Gusher AKA Tide Pod Challenge
In 2017, poison centers reported 10,570 laundry pod exposures involving children less than 5yr old. Laundry detergent pods have a higher probability of complications than liquid detergent exposures. Approximately one fourth of cases were related to storing the pods inappropriately.  
Now that 2018 is here, a new social media phenomenon called the “Tide Pod Challenge” is causing an increase in cases in adolescents. No, these young adults are not doing their laundry; teens across the country have been uploading videos of themselves ingesting a laundry detergent pod in order to gain views on their social media page.  

Anatomy of a Gusher
Ingredients are often more concentrated in the laundry pod form than the liquid detergent form. The basic composition of laundry detergent includes:  anionic surfactants, alkaline builders, non-ionic surfactants, polymer, and propylene glycol encased under pressure in a water-soluble membrane covering that dissolves with liquid contact. It has a pH range of 6.8 to 7.4.  

Common Scenario
Ingestion is the most common route with symptoms of upset stomach, nausea, vomiting, coughing, choking, wheezing, and mucosal irritation. Most children and teens do well and do not require further treatment other than thoroughly rinsing that mountain spring odor out of their mouth, oral liquid trial, and observation at home for worsening or new symptoms. Your GI physicians can rest easy with the risk of esophageal stricture being very unlikely and routine evaluation with endoscopy is not currently recommended unless clinically indicated.  

Scenarios of Concern
Respiratory distress with hypoxia can occur with aspiration of the detergent or with a foreign body occluding the airway.  Aspiration can occur a few ways, the pod can become lodged into the posterior pharynx placing it under pressure, the water-soluble casing then dissolves, and the contents gush into the airway causing aspiration. The casing itself can also be aspirated occluding the airway; and although the covering is water soluble, it takes time for the body’s secretions to dissolve the casing completely.  

More commonly, due to the pressure within the laundry pod, saliva weakens the membrane and when a drooly toddler bites down with their gummy bite, laundry soap shoots into the back of their throat. This frightens them, and causes aspiration of the soap to occur. Laundry detergent is also a surfactant; once aspirated, it coats the lungs, not only preventing oxygen exchange, but potentially causing chemical burns to the lung tissue. This scenario has resulted in many children requiring intubation and ventilation, and has even resulted in death in many children across the country. 

Just because it has Downy does not mean it is a downer. CNS depression has also been seen with the exact mechanism being unknown; yet it has been seen in up to 8% of cases. The literature shows that patients with altered mental status and respiratory symptoms often required intubation.

But that’s not ALL (pun intended), ophthalmic exposure can lead to corneal abrasions; where as, dermal injuries from prolonged exposure to the skin causing second degree and even third degree burns have been reported even after the family has “washed off” the detergent.   
The Tennessee Poison Center refers in all children who present on initial call with persistent cough, difficulty breathing, or lethargy / CNS depression post laundry pod ingestion.

Take Home Points 

While “The Tide Pod Challenge” is making headlines for teens, exposure is mostly seen in children < 5years old.   

Almost 1/4th of pod exposures were related to inappropriate storage; therefore, prevention starts with educating families on keeping harmful substances stored safely high and out of sight.  
Vomiting is the most common symptom reported, and it does not necessarily warrant a trip to the ED.  

If aspiration is suspected, patients should be seen in an emergency room for difficulty breathing and respiratory support. 

A clinical picture of altered mental status and suspected pulmonary injury can potentially require intubation.

For skin exposure, removal of contaminated clothing and thorough decontamination with copious amounts of water is required to prevent chemical burns.

Ophthalmic exposure requires copious irrigation and should be evaluated for corneal abrasions. 

Hopefully, you have Gained some insight on this toxicology trend! Any questions, contact your friendly neighborhood toxicologist at 1-800-222-1222

This Question was prepared by Robert Stewart, MD

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu

Donna Seger, MD
Medical Director
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222