Laundry ‘pods’: more toxic than your mom’s detergent

June 8, 2013, 1:46 pm

Tide laundry pod

Tide laundry pod

★★★½☆

Laundry Detergent “Pod” Ingestions: A Case Series and Discussion of Recent Literature. Beuhler MC et al. Pediatr Emer Care 2013;29:743-747.

Abstract

In 2011, laundry “pods” were introduced into the United States market. These colorful products are formulated by sealing concentrated liquid detergent inside a water-soluble casing (polyvinyl alcohol). Pods look somewhat like pieces of candy, and can be enticing to young children. Although ingestion of laundry powder or liquid by toddlers usually causes only mild symptoms such as vomiting or mucosal irritation, exposure to the contents of a laundry pod may result in more severe toxicity.

This case series describes four young children who developed significant toxicity after biting into laundry pods. All patients presented with some degree of mental status depression and respiratory distress. Three were intubated, and two required hospitalization for at least one week. Other findings included vomiting, metabolic acidosis, elevated lactate,  epiglottic swelling, difficulty swallowing, and evidence of aspiration.

In their discussion, the authors note that caustic injuries from these products are likely caused by surfactants, and metabolic acidosis with elevated lactate by propylene glycol (which is metabolized to lactic acid).  It is not clear what component is responsible for the presence of decreased or waning-and-waning mental status.

The authors conclude that in these cases “practitioners should be vigilant for rapid onset of neurological impairment and inability to protect the airway in addition to [the] caustic effects.”

The June issue of Pediatric Emergency Care contains two other articles about laundry detergent “pod” ingestion. A case report by Schneir et al. from UC-San Diego describes a 15-month-old girl who required intubation for 5 cays because of bronchospasm and oxygen desaturation after ingesting part of a “pod”. Heppner and Vohra fro UCSF-Fresno present a similar case, and point out that exposure to laundry detergent pods can affect the following systems:

  • Gastrointestinal: nausea, vomiting, mucosal lesions
  • Pulmonary: coughing, stridor, aspiration, bronchospasm, oxygen desaturation, acute respiratory distress syndrome
  • Metabolic: metabolic acidosis, increased lactate
  • Ocular: keratitis
  • CNS: sudden and profound decreased mental status

The authors note that the deterioration in mental status — not usually seen after ingestion of laundry powders or liquids — can occur as early as 20 minutes after exposure.

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