Sodium Hypochlorite

CAS RN:7681-52-9

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Supportive care and removal from exposure or decontamination are the mainstays of treatment. Remove contaminated clothing and copiously irrigate exposed eyes or skin with water or saline. Patients with respiratory exposures should leave the area of exposure immediately and receive supplemental oxygen, bronchodilators, and advanced airway support (eg, intubation) as necessary. Nebulized sodium bicarbonate (3.75%) has been used to treat respiratory irritation after chlorine inhalation in some cases and is suggested by some experts. Dilute with small amounts of milk or water following an ingestion.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Standard burn care should be applied for serious ocular and dermal corrosive effects. Severe respiratory distress requires intubation. For ingestions of hypochlorite solutions greater than 10% or symptoms of severe corrosive injuries (ie, dysphagia, drooling, pain), flexible endoscopy should be performed to evaluate the extent of esophageal or gastric injury. Chest and abdominal x-rays may be useful to look for mediastinal or intraabdominal free air secondary to perforations in the gastrointestinal tract, which require surgical intervention.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: For ingestions, dilute with small amounts of milk or water. Activated charcoal is CONTRAINDICATED. Remove contaminated clothing, wash exposed skin, and irrigate exposed eyes with normal saline or water following dermal exposure.
    • 2) HOSPITAL: Gastric aspiration could be helpful for large and relatively recent ingestions of high concentration hypochlorite solutions, but this entails the potential risk of damage to a burned esophagus. Remove contaminated clothing, wash skin, and irrigate exposed eyes until ocular pH is normal.
  • D) AIRWAY MANAGEMENT
    • 1) For respiratory exposures to chlorine and chloramine gas, severe exposures may require intubation, especially for those showing signs of airway edema or obstruction (ie, croupy cough, hoarseness, stridor) or those in severe respiratory distress secondary to pulmonary edema.
  • E) ANTIDOTE
    • 1) None.
  • F) ENHANCED ELIMINATION
    • 1) There is no role for enhanced elimination.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Patients with minimal inadvertent exposures who remain asymptomatic or develop mild symptoms with resolution may remain at home.
    • 2) OBSERVATION CRITERIA: All patients with persistent symptoms or intentional exposures should be sent to a health care facility for observation for the longer of 4 to 6 hours or until symptoms resolve. Criteria for discharge should include symptom resolution.
    • 3) ADMISSION CRITERIA: Patients with persistent symptoms after a period of observation and supportive treatment should be admitted to the hospital. Depending on the severity of the symptoms (eg, intubation for pulmonary edema), an ICU bed may be needed. Criteria for hospital discharge should be improvement or resolution of symptoms.
    • 4) CONSULT CRITERIA: Depending on the route of exposure and symptoms, it may be appropriate to consult a burn specialist, gastroenterologist, ophthalmologist, or intensivist. For large-scale exposures, public health and hazardous materials personnel should be notified. A poison center, medical toxicologist, or both should be contacted for moderate to severe exposures.
  • H) PITFALLS
    • 1) For ingestions, lack of significant initial damage in the oropharynx does not mean deeper, significant gastrointestinal injury cannot develop. Physical exertion can exacerbate symptoms during an ongoing respiratory exposure, as the total exposure will increase with increased minute ventilation.
  • I) TOXICOKINETICS
    • 1) Most patients will have at least mild symptoms immediately.
  • J) PREDISPOSING CONDITIONS
    • 1) Patients with bronchospastic disease may be more sensitive to respiratory exposures, especially children, since they have smaller airways than adults.
  • K) DIFFERENTIAL DIAGNOSIS
    • 1) The differential diagnosis can include contamination by other caustic substances or exposure to other irritant gases. Other nontoxic etiologies can cause similar symptoms (ie, burns, respiratory distress).
0.4.3 INHALATION EXPOSURE
  • A) Remove from exposure, administer oxygen, bronchodilators for wheezing or persistent cough. Nebulized sodium bicarbonate (3.75%) has been used to treat respiratory irritation after chlorine inhalation in some cases and is suggested by some experts. Intubation should be performed early in patients with evidence of upper airway edema (eg, stridor, severe respiratory distress).
  • B) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
0.4.4 EYE EXPOSURE
  • A) Immediate copious eye irrigation until pH is neutral. Slit lamp exam, with emergent referral to an ophthalmologist if there is any evidence of ocular burns.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) REMOVE ALL EXPOSED CLOTHING AND WASH EXPOSED AREAS of the body twice with water. Standard burn care (eg, dressings, antibiotic ointment) for corrosive injuries. Wash all exposed clothes with soap and water. Complications are unlikely. A physician may need to examine the exposed area if pain or irritation persists after the area is washed.
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