Sodium Hypochlorite Poisoning - Symptoms and Treatment

Introduction:

Bleach, water purifiers, and cleaning supplies frequently contain this chemical substance, sodium hypochlorite. Sodium hypochlorite is a caustic substance. It might injure the human tissues if it comes into contact with it. Poisoning can result from ingesting sodium hypochlorite or from inhaling sodium hypochlorite fumes, particularly if the substance is combined with ammonia. In general, chlorine has been extensively studied because it was specifically used as a chemical warfare agent during World War I. No evidence of long-term lung damage from chlorine gas inhalation was found in follow-up studies of survivors.

Where Is Sodium Hypochlorite Found?

Mostly, the home care solutions contain sodium hypochlorite because it is a potent and quick-acting disinfectant that fights a variety of microorganisms, including bacteria and viruses. The primary chemical in the majority of household bleaches is sodium hypochlorite. In the course of water processing, sodium hypochlorite is used to treat drinking water. E. coli and cyanotoxins, which are prevalent in water because of fecal contamination and produced by cyanobacteria, respectively, are the two contaminants that sodium hypochlorite treatment attempts to remove. Sodium hypochlorite is the substance used to add to swimming pools. It is commonly found in disinfectants, bleaching agents, and water purifiers. While industrial bleaches can contain up to 50% sodium hypochlorite, household bleach can contain as little as 10%. Accidental domestic exposures to chlorine are fairly common and are caused by improperly combining household cleaning products or mishandling swimming pool disinfectants.

What Are the Common Routes of Exposure?

• Accidental ingestion is the primary way that children are exposed to sodium hypochlorite solution, whereas ingestion in adults is relatively uncommon.

• Adults are most frequently exposed through the inhalation of gasses created when sodium hypochlorite is combined with acidic or alkaline solutions. Exposure to the eye or skin is also possible.

What Are the Symptoms of Sodium Hypochlorite Poisoning?

When exposed to sodium hypochlorite, symptoms can appear right away or take several hours to appear. The following signs of sodium hypochlorite poisoning include

• Burning and red, watering eyes.

• Erosive esophageal burns.

• Tightness or pain in the chest.

• Coma (lack of responsiveness).

• Coughing (from the fumes).

• Delirium (agitation and confusion).

• Drooling.

• Feeling nauseous and gagging.

• Low blood pressure.

• Discomfort in the throat or mouth.

• Burns, blisters, or rashes on the exposed skin.

• Shock (extremely low blood pressure).

• Slow heart rate.

• Stomach discomfort or pain in the abdomen.

• Swelling of the throat, which makes breathing difficult.

• Vomiting, occasionally bloody.

• Weakness.

Can Acute Exposure to Sodium Hypochlorite Cause Delayed Symptoms?

Most kids who consume bleach swallow very little of it and only experience nausea and gastrointestinal discomfort. However, aspiration is the cause of pulmonary complications like ARDS (Acute Respiratory Distress Syndrome). Potential aftereffects of ingesting sodium hypochlorite solution include esophageal obstruction, pyloric stenosis, vocal cord paralysis, bleeding, perforation, scarring, and stricture formation following corrosive injury to the mouth, throat, esophagus, and stomach. Some evidence suggests that long-term neuropsychological changes may also be related to chlorine exposure.

What Are the Health Effects After Acute Exposure to Sodium Hypochlorite?

1. General Health Effects

• Although sodium hypochlorite solution by itself is only mildly toxic, when combined with acidic cleaning agents, chlorine gas is released.
• Chloramine compounds are created when sodium hypochlorite and ammonia-based solutions are combined. Strong respiratory irritants, both chlorine and chloramines, contribute to toxic effects.

2. Inhalation

• It is extremely uncommon for people to become intoxicated after breathing in sodium hypochlorite vapors because bleach solutions normally do not release significant amounts of chlorine gas.
• The inhalation of sodium hypochlorite solution is toxic primarily as a result of the bleach and acid mixture, which releases highly irritating gasses. Rarely, metabolic acidosis can happen after significant sodium hypochlorite inhalation.
• In a few rare instances, breathing in chlorine gas, which is created when sodium hypochlorite and acid are combined and causes immediate burning in the throat and lungs, irritation of the eyes and nose, tightness in the chest, coughing, sore throat, wheezing, and dyspnea.
• Moreover, the development of bronchospasm, pneumonitis, upper airway edema, pulmonary edema, or glottis edema is possible in severe cases. Breathlessness and bronchospasm may develop after a latent period of 5 minutes to 15 hours, which occurs in the majority of cases when respiratory irritation occurs immediately.
• In the majority of cases, symptoms disappear within a week or two. However, in some cases, lung damage may result in chronic reactive airway dysfunction syndrome (RADS), a form of asthma caused by chemical irritants after acute respiratory exposure to an irritant gas.

3. Ingestion

• Sodium hypochlorite is a mild to moderate irritant at low concentrations (up to 10%), such as those found in household bleach, but it rarely causes necrosis or significant mucosal injury. Recovery from ingestion is typically quick, and severe or long-lasting damage is not anticipated.
• Small doses of sodium hypochlorite solution (10%), up to 200 mL for adults and 50 mL for children, usually have little impact on health.
• It can occasionally result in stomach, mouth, throat, esophagus, and pharyngeal burns, as well as gastrointestinal irritation, nausea, and vomiting. There may also be dysphagia, stridor, drooling, abdominal pain, and dyspnea.
• Unless contact is prolonged or a large volume is consumed, severe irritation is uncommon. Any amount of household bleach (10% sodium hypochlorite) or industrial strength bleach (greater than 10% sodium hypochlorite) may cause corrosive oesophagitis, haematemesis, abdominal and retrosternal pain, diarrhea, and, in rare cases, melaena and metabolic acidosis if consumed in large doses (approximately 300 mL in adults; 100 mL in children).
• Rarely, the gastrointestinal mucosa may bleed, ulcerate, and perforate, which can result in shock. After ingesting extremely high volumes of sodium hypochlorite, hypernatraemia, hyperchloraemia, hypotension, and cardiovascular collapse may rarely occur.

4. Dermal/Ocular Exposure

• Being corrosive, sodium hypochlorite itself can irritate skin and cause burning pain, swelling, and blisters. Skin damage might not be visible right away and might keep getting worse over time.
• If eyes are immediately washed after contact with household bleach, mild irritation and temporary discomfort may occur. If the eyes are not washed, irritation worsens and lasts longer.
• Pain, blepharospasm, lacrimation, conjunctivitis, photophobia, necrosis and chemosis of the cornea, clouding of the cornea, iritis, cataract formation, and retinitis can all be caused by more concentrated solutions.

What Happens if Being Repeatedly or Constantly Exposed to Sodium Hypochlorite?

Skin irritation may result from prolonged dermal exposure to sodium hypochlorite solution. In the literature, cases of allergic contact dermatitis have been documented. However, data on the effects of drinking water containing sodium hypochlorite are scarce.

How Is Sodium Hypochlorite Poisoning Treated?

• The patient's vital signs, such as their temperature, pulse, breathing rate, and blood pressure, will be measured and observed by the healthcare provider. Symptoms will be managed properly.

• The patient might get breathing assistance from a breathing machine (ventilator), intubation, and airway support with oxygen.

• Urine and blood tests.

• Assessing burns in the airways with a camera down the throat (bronchoscopy).

• Endoscopy with a camera down the throat to look for burns in the stomach and esophagus.

• CT (Computed Tomography).

• Chest X-ray.

• ECG scan (Electrocardiogram).

• Administration of fluids or medications intravenously.

• Treatment options for skin exposure may include irrigation (skin washing), possibly several times per day for several days.

• Burned skin removal through surgery (skin debridement).

• To continue receiving treatment, the patient might need to be admitted to a hospital. If the esophagus, stomach, or intestines have holes (perforations) from the acid, surgery might be required.

What Can a Person Do Before Going to the Hospital or the Emergency Service Reach Your Place on Acute Exposure to Sodium Hypochlorite?

• For at least 15 minutes, flush with water if the chemical is on the skin or in the eyes.

• If the chemical was ingested, the person should be given water or milk right away unless otherwise directed by a healthcare provider. If the individual is experiencing symptoms that make it difficult for them to swallow, such as vomiting, convulsions, or a loss of alertness, do not give them water or milk. Move the person to fresh air right away.

• Find out the information about the age, weight, and health of the individual, the brand of the item (ingredients and strengths, if known), the duration of its consumption, and the volume ingested.

Conclusion:

It is important to note that it is dangerous to combine bleach with everyday cleaning supplies. Prior to applying a cleaning product, it is imperative to always read the product label. The poisoning due to sodium hypochlorite is relatively low, and the effects are commonly mild and moderate, and symptomatic management can assist the patients with symptoms, which almost result in complete recovery. However, immediate medical attention is crucial to prevent severe symptoms and complications.