Bleach Ingestion - Mechanism, Symptoms, and Treatment

Introduction

Bleach can be either a chlorine-based or a peroxide-based chemical. It is a compound used in most homes and workplaces as a disinfectant and whitening agent because of its ability to kill a wide variety of pathogens and being cost-effective, it is used worldwide.

This widespread nature of the chemical increases its chances of an accidental and potentially toxic ingestion. Different concentrations of bleach are available in the market; typical household bleach ranges from three to five percent at this level. It does not cause any damage beyond local irritation and minimal gastrointestinal effects. However, higher concentrations of bleach (up to 35 %) have been known to be used in industries and hospitals, and at this level, it has the potential to cause caustic injury. Although it is not life-threatening, it can cause severe complications like strictures, perforations, hypernatremia (excess sodium in the blood), etc.

For household bleach ingestions, conservative home management and supportive care would be sufficient, but ingestion of a higher dose of bleach would require emergency care.

What Is the Mechanism Behind the Action of Bleach?

Bleach has two functions-

1. Discoloration - The commonly used household bleach causes discoloration or whitening by a mechanism called oxidation. Oxidation, by definition, means a gain in oxygen, the chlorine in the bleach reacts with the water (from the atmosphere or when diluted) and forms hypochlorous acid. Hypochlorous acid is unstable in nature, and it easily dissociates to form an acid and nascent oxygen. This oxygen molecule breaks the chemical bonds of the pigments, resulting in a loss of color. Some chemicals cause bleaching by reduction, too, but they are not used in regular households.

2. Denaturation- This is the disinfecting part of the bleach. The acid and the oxygen released when the bleach comes in contact with water also denature (break the bonds) the proteins in bacteria. As a result, the molecules in the organism start to clump and liquefy, leading to its death, called liquefactive necrosis. The denaturation depends on the concentration of the bleach; for example, one percent of hypochlorite bleach can kill coronavirus in a minute. These effects of bleach are magnified when combined with other chemicals; for example- bleach is often mixed with ammonia to kill weeds, preserve cut flowers, etc.

How Does Bleach Ingestion Occur?

The ubiquitous nature of bleach makes individuals easily susceptible to its ingestion. The different forms of bleach that can cause its exposure is-

1. Aerosol - Aerosolized form of bleach is preferred by many individuals due to its ease of application. When sprayed, the bleach molecules can be inhaled easily, affecting the lungs, eyes, and skin.

2. Immersion - Bleach is a common disinfectant used for cleaning swimming pools. Accidental bleach overdose while cleaning can affect the swimmers' eyes, skin, and stomach (if swallowed).

3. Ingestion - Some individuals intentionally ingest bleach due to emotional instability; often, they mix it with other chemicals like toilet bowl cleaners and other household cleaners. This can cause asphyxiation (oxygen deprivation), which can be life-threatening.

4. Aspiration - Occasionally, bleach can be inhaled accidentally, which will cause damage to the lungs.

What Are the Symptoms of Bleach Ingestion?

Diluted bleach causes only mild-stomach irritation; however, industrial strength, which is at higher concentration, will cause serious symptoms, some of which are-

• Burning of the eyes.

• Burns in the windpipe.

• Tightness in the chest.

• Coma.

• Cough due to the fumes.

• Irritation of the exposed skin.

• Low blood pressure.

• Swelling of the throat will cause difficulty in breathing.

• Bradycardia (reduced heartbeat).

• Vomiting.

• Weakness.

• Stomach pain.

• Drooling.

• Gagging sensation.

• Delirium.

• Shock.

The symptoms depend on the concentration of the product, volume of ingestant, duration of exposure, and potential co-ingestants.

How Is Bleach Ingestion Treated?

Treatment depends on the severity of the symptoms. If the ingestion is accidental and the symptoms are not severe, treatment can be done at home; this includes-

• Flush the eyes.

• Wash the exposed area with water and soap.

• Drinking water or milk will be soothing if the chemical is swallowed.

If the symptoms are severe, the individual must be admitted to a hospital where the provider will measure and monitor the person’s vital signs. The following investigation will be done to assess the damage-

• Blood and Urine Tests - These are done to check for signs of inflammation that might take place after ingestion.

• Bronchoscopy- Done to check for any burns in the airway.

• Endoscopy - This is performed to check for burns in the esophagus (food pipe) and the stomach.

• Chest X-ray - This will help to confirm tracheal (windpipe) inflammation and pulmonary (lungs) edema (swelling).

• Computerized tomographic (CT) scan - It is a less invasive procedure than endoscopy to detect organ burns.

• Electrocardiogram (ECG) - to check for any signs of bradycardia (reduced heart rate).

Based on the investigations, the patient may receive the following:

1. In case of accidental exposure to the eyes, the patient will be given a topical anesthetic like Tetracaine or Proparacaine to help control the pain. Additionally, the eyes will be irrigated with copious amounts of saline to prevent or reduce corneal edema.

2. Albuterol is given to patients who inhale bleach and show signs of bronchospasm (narrowing of the muscles in the lungs). More aggressive treatment will be necessary for asthmatics (individuals suffering from asthma).

3. In patients who have ingested bleach, inducing vomiting through activated charcoal or other methods is contraindicated due to the risk of secondary burns and aspiration.

4. Patients should be given plenty of water or milk to reduce the bleach concentration.

Apart from these, patients should be placed on a cardiac monitor, and venous access should be obtained. Careful attention should be paid to the airway, breathing, and circulation, and if the patient is suffering from hyperchloremic metabolic acidosis, intravenous bicarbonate or buffer solutions can be started.

Can Bleach Ingestion Be Prevented?

• Bleach ingestion is a preventable injury; individuals are advised to familiarize themselves with safety precautions before using it.

• Proper labeling and storage are mandatory while handling strong chemicals; care should also be taken not to mix chemicals.

• While handling bleach, it is advised to wear safety goggles, long-sleeved garments, and gloves to prevent exposure.

• Adequate ventilation is necessary while bleaching indoors, and pets and children should be kept away from the bleached area for at least 8 hours to 12 hours.

• Patients with known lung conditions should avoid using bleach, as the fumes will only worsen the preexisting condition.

Conclusion:

Bleach ingestion is often accidental, with many recovering without any residual effects. The major organs affected are the skin, eyes, lungs, and gastrointestinal tract. Skiing and eye irritation can be resolved with thorough irrigation with water, lungs, and gastrointestinal tract; however, they will need medical intervention. Long-term follow-up is advised in these patients to prevent complications.