Liquid Laundry Detergent Capsules

Introduction: 

Liquid soap capsules (also known as disposable detergent bags; laundry bags; laundry bags) have become increasingly popular household products worldwide.

Laundry powder containers are an increasingly popular household cleaning product. During the wash cycle, the pink laundry pods are immersed in water, causing the shell to break and release the detergent. Detergent packs can release their contents prematurely if they come into contact with moisture (such as in a child's mouth), or if they are subjected to enough stress to burst (including being bitten or squeezed by a small child).

There are several routes of exposure to cleaners and children in the environment, including ingestion, skin contact, and eye contact. Detergent ingestion can cause a number of systemic symptoms, including dyspnea, vomiting, diarrhea, and central nervous system depression. Severe reactions can lead to pneumonia, throat swelling, and upper airway inflammation, requiring intensive care. Skin contact may cause itching, blistering and burning. The face is most commonly involved, followed by the hands and fingers

Conjunctivitis was the most commonly described feature of the exposed eye, followed by corneal abrasions or epithelial abnormalities. Although healing of corneal abrasions is usually rapid, severe morbidity can occur, with healing delays of more than two weeks reported. In 2015, it was estimated that one in four chemical eye injuries in the United States were related to soap packages.

At our tertiary eye center in Ontario, Canada, we unfortunately see 10 to 15 children with this presentation each year. Also, interestingly, over the past year, we have seen an increase in cases during the COVID-19 crisis. We suspect that children spend more time indoors and have more opportunities to dispose of soap boxes at home.

Public health efforts have been made to encourage detergent box manufacturers to limit exposure of their products to children. Some manufacturers have implemented better warning icons, opaque packaging and childproof covers. However, it is unclear whether adverse exposure to detergent pods has decreased at the population level following such interventions. To complicate matters, off-brand and generic detergent capsules usually do not include child-resistant packaging and manufacturing.

Rose laundry powder boxes are a common household cleaning product that carries considerable risk. New efforts are clearly needed to reduce illness associated with detergent packs. From a manufacturing and marketing perspective, more work needs to be done to reduce childhood illness associated with exposure to these potentially harmful products.

Objectives: 

Review liquid detergents, capsule composition and mechanisms of toxicity as well as environmental, route, clinical properties (and effects of packaging changes) and exposure management.

Methods:

Search the PubMed and EMBASE databases using the following terms: "detergent" and "capsule", "pod", "pac" or "bag" with "poison", "ingest", "expose". Combined, but "animal" or not. "in vitro" or "bacteria". 289 articles were retrieved, of which 186 were excluded: 38 duplicates, 133 unrelated, 10 abstracts as papers and 5 non-English articles. A manual search of bibliographies for relevant articles yielded 14 additional citations A search of scientific conference abstracts yielded 5 additional citations A total of 122 publications were relevant to the objectives of the review.

Capsules and composition:

Capsules typically contain anionic surfactants (20–35%), nonionic surfactants (10–20%), propylene glycol (8–20%), and ethanol (2–5%) within a water-soluble polyvinyl alcohol film. There are.

Mechanisms of toxicity: 

Nonionic surfactants are the primary mechanism, although anionic surfactants, ethanol and propylene glycol may also play a role.

Circumstances of exposure: 

Most (60%) babies are exposed when capsules are removed from their original containers.

Routes of exposure: 

Ingestion was most common (>85%); Ocular (<15%) and skin (<8%) exposures were residual.

Features following ingestion:

Features occur in approximately half of exposures, although >90% are secondary. Among those with the characteristics, vomiting occurs in about 50%; Cough and lethargy are reported in <5%. Respiratory depression (<0.5%), central nervous system depression (<0.1%), esophageal or gastric injury (<0.5%), metabolic acidosis, and hyperlactatemia (<0.05%) were rarely reported. Of the 17 deaths reported, 13 were adults and 9 had cognitive impairment.

Features following ocular exposure: 

Conjunctivitis, eye irritation, and/or eye pain are common; Corneal damage is less common, but usually heals completely within a week.

Features following dermal exposure:

Clinically significant skin toxicity is rare, although prolonged skin contact may cause skin burns in <5% of cases.

Impact of packaging changes on features: 

The implementation of packaging changes resulted in a reduction in the number and severity of exposures in the United States and Italy.

Management-ingestion: 

Bowel cleansing is not recommended, although a small amount of oral fluid may be gargled. All patients with toxic features should be offered symptomatic and supportive care. Hypoxemia should be supplemented with oxygen and bronchodilators given for laryngospasm/bronchospasm. Intubation and assisted ventilation may be required if CNS and respiratory depression is present. If respiratory features are present, a chest radiograph should be performed. Patients with dysphagia, drooling, or oropharyngeal burning should undergo endoscopy; If significant mucosal damage is present, MRI should be considered. Also, if prolonged vomiting or diarrhea occurs, intravenous fluids are needed, and acid-base disorders must be corrected.

Management-eye exposure: 

The eyes need to be cleaned thoroughly with 0.9% sodium chloride. Administration of a local anesthetic will reduce discomfort and facilitate more complete decontamination. Because of the possibility of corneal damage, fluorescein should be administered. If trauma to the eye is present, the patient should be referred to an ophthalmologist.

Management-skin exposure: 

Skin should be washed thoroughly with soap and water, and burns should be treated as thermal burns.

Conclusions: 

Accidental ingestion usually produces no or only mild symptoms. Respiratory depression, central nervous system depression, esophageal or gastric injury, hyperlactatemia, and metabolic acidosis occur rarely. Eye contact rarely damages the cornea, and skin irritation may rarely occur after prolonged skin contact. Of the 17 deaths reported, 13 were adults and 9 had cognitive impairment.

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