5-06-2020 When is Bleach Dangerous?

Toxicology Question of the Week

When is Bleach Dangerous?

Most household bleaches are dilute hypochlorite 3-6 % solutions. Hypochlorite is an aqueous solution produced by mixing chlorine gas with water. Household bleach containing products are commonly used as laundry bleach, toilet bowl cleaners and bathroom cleaners. Stronger strength hypochlorites are used as industrial strength cleaners (20% hypochlorite), and as swimming pool chlorinators or pool ‘shock’ (60-90% hypochlorite as Calcium hypochlorite or Sodium dichloroisocyanurate).

The Tennessee Poison Center has seen a 23% increase in calls associated with bleach over the last three months compared with the same time period in 2019. Most are accidental exposures to household bleach solutions with mild local effects and can easily be managed at home. Only a small percentage of exposures involve stronger more concentrated products and are more likely to cause serious corrosive injury requiring referral to a hospital.

Exposure to hypochlorite solutions can cause effects ranging from mild irritation to corrosive injury of the GI tract, eyes, skin and respiratory tract. Severity of clinical presentation depends on concentration and size of exposure.

Exposure to 3-6 % household hypochlorite solutions can cause mild irritation and burning of the mouth and throat with ingestion, rapid onset of symptoms such as burning of the eyes, nose and throat and coughing with inhalation, and mild irritation with dermal exposure. Accidental exposures to household bleach containing products cases can be managed at home. With ingestion, give clear fluids to dilute and do not induce vomiting. With inhalation, move away from the fumes and into fresh air. Wash exposed skin with water for 10-15 minutes and remove contaminated clothing

Mixing of bleach with other household cleaners can release strong gases.  When mixed with ammonia containing cleaning products, chloramine gas is released. When mixed with other acid containing products like vinegar and toilet bowl cleaners containing hydrochloric acid, chlorine gas is released. Exposure to these gases can cause more severe inhalation effects.

Exposure to concentrated hypochlorite solutions or fumes can cause more severe effects such as drooling, vomiting, abdominal pain, and serious corrosive effects to the esophagus and stomach. Inhalation can cause persistent coughing, wheezing and shortness of breath and may result in chemical pneumonitis. Dermal exposure can cause serious corrosive burns to the skin. Such cases will require referral to the ER for further evaluation and treatment.

In case of exposure, do NOT induce vomiting, and immediately call the Tennessee Poison Center for advice.

Prepared by Suparna Kumar, MD, CSPI- Certified Poison Specialist at the Tennessee Poison Center

References:

Poisoning and Drug Overdose (Lange Clinical Manual)

Micromedex

Webpoisoncontrol.org

I guess we shouldn't be surprised that the TN Poison Center has received an increased number of calls regarding bleach/disinfectant. Overall, toddlers that get into household bleach do fine. But, making a bathroom cleaner by mixing bleach with ammonia releases chloramine- a gas irritating enough that the room needs to be evacuated and windows opened. BTW, injection of bleach would cause terrible vein sclerosis. ds

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@vumc.org.

Donna Seger, MD

Executive Director

Tennessee Poison Center

www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222