View source for Laundry detergent pod ingestion

==Background==
[[File:Laundry detergent pods.jpg|thumb|Laundry detergent pods]]
[[File:Spring Meadow Tide pod.jpg|thumb|A "Spring Meadow" Tide Pod, a brand of detergent criticized for its candy-like appearance.]]
*Laundry detergent pods that contain more concentrated detergent than liquid detergents, and contain ethoxylated polymers, ethoxylated alcohols, surfactants, as well as other unknown proprietary ingredients
*Considered to cause caustic hydrocarbon injury
*Size and colorful packaging makes pods a risk for pediatric ingestion

==Clinical Features==
In a review of 202 cases<ref>Beuhler MC, Gala PK, Wolfe HA, et al. Laundry detergent “pod” ingestions: a case series and discussion of recent literature. Pediatr Emerg Care. 2013; 29(6):743–747. </ref><ref>Valdez, A et al. Pediatric Exposure to Laundry Detergent Pods. Pediatrics. 2014.  http://media.kshb.com/pdf/Pediatric%20Exposure%20to%20Laundry%20Detergent%20Pods.pdf</ref>
*No effects - 24%
*[[Vomiting]] - 66%
*Respiratory complaints ([[cough]], [[stridor]], [[SOB]], [[pneumonitis]], [[respiratory failure|respiratory depression]]) - 16%
*[[Altered mental status]] - 9%
**Can be profound
*Eye irritation - 8%
**Cause alkaline [[caustic eye exposure]], [[conjunctivitis]]
*Skin irritation - 0.5%
**2nd/3rd degree [[chemical burns]] described<ref>Russell JL1, Wiles DA, Kenney B, Spiller HA. Significant chemical burns associated with dermal exposure to laundry pod detergent. J Med Toxicol. 2014 Sep;10(3):292-4</ref>
*[[Fever]] - 0.6%

*Red flag findings (indicate potential need for endoscopy, risk of perforation)-  stridor, excessive drooling, persistent vomiting

==Differential Diagnosis==
===[[Hyperthermia]]===
*Altered Metabolism
**[[Aspirin (Salicylate) Toxicity]]
**[[Benzodiazepine withdrawal|Benzo]] or [[alcohol withdrawal]]
**[[Thyroid storm]]
**dinitrophenols
*Increased Muscle Activity
**[[Sympathomimetic toxicity]], alcohol withdrawal
**[[MAOI Toxicity]]
**[[Phencyclidine]], LSD
**[[Lithium toxicity]]
**Amoxapine
**[[Serotonin Syndrome]]
*Impaired Heat Dissipation
**[[Anticholinergic toxicity]]
**[[Antihistamines]]
**[[TCA toxicity]]
*[[Malignant Hyperthermia]]
**anesthetics
*[[Neuroleptic Malignant Syndrome]]
**[[Phenothiazines]], [[Lithium]], LevoDopa

===[[Hypothermia]]===
*Exposure
**[[Ethanol Toxicity]]
**[[Sedative/Hypnotics]]
**[[Opioids]]
**[[TCAs]]
**[[Phenothiazines]]
**[[Insulin]] ([[Hypoglycemia]])

===Increased Respiratory Rate===
*Direct Stimulation
**[[Aspirin (Salicylate) Toxicity]]
**[[Metabolic acidosis]]
**dintirophenol, pentachlorophenol
**[[Hepatorenal syndrome]]
**CNS stimulants (cocaine, amphet, theophylline)
*Tissue [[Hypoxia]]
**[[CO]]
**[[Cyanide]]
**[[Hydrogen Sulfide]]
**[[Methemoglobinemia]]

===Respiratory Depression===
*Central Depression
**[[Antipsychotics]]
**Chlorinated hydrocarbons
**[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols)
**[[Tricyclic (TCA) Toxicity]]
**[[Lomotil toxicity|Lomotil]]
*Muscle Failure
**[[Organophosphates]]
**[[Marine Toxins]]
**[[Nicotine Poisoning|Nicotine]]
**[[Strychnine]]
**[[Botulism]]
**Mojave [[rattlesnake]], cobra

==Evaluation==
*BMP
*[[VBG]]/[[lactate]]
**[[Lactic acidosis]] reported<ref>Schneir AB, Rentmeester L, Clark RF, Cantrell FL. Toxicity following laundry detergent pod ingestion. Pediatric Emergency Care, 2013 Jun 1; 29(6): 741–2.</ref>
*[[CXR]] if respiratory complaints 
**May be delayed [[pneumonitis]]
*Assess for co-ingestions if there is sufficient concern


==Management==
*ABCs
**Consider intubation for significant respiratory compromise
*Decontamination/eye irrigation if external exposure
**Irrigate eye until pH neutralizes
**Fluorescein exam for [[corneal abrasion|corneal defects]]
*[[Antiemetics]] for nausea
*Correct electrolyte abnormalities if present
*Contact Poison Control
*Red Flag signs: stridor, excessive drooling, persistent vomiting- may need endoscopy within 12-24 hours (after 24 hours, greater risk of perforation)

==Disposition==
*Monitor in ED in conjunction with Poison Control recommendations
*Consider 6-hour observation period from time of ingestion, as some symptoms may be delayed 
*Consider admission if respiratory compromise, altered mental status, or GI complaints resistant to symptomatic treatment

==See Also==
*[[Toxicology (main)]]

==External Links==
*[http://www.thepoisonreview.com/2013/06/08/laundry-pods-more-toxic-than-your-moms-detergent/ The Poison Review - Laundry ‘pods’: more toxic than your mom’s detergent]

==References==
<references/>

[[Category:Toxicology]]