Common non-toxic exposures (and what to expect)
As clinicians, we will occasionally come across someone with a case of Toxicophobia – the fear of being poisoned. In paediatrics, this usually presents in the parents of a little one who has explored their way into something they shouldn’t have. Whilst developmentally normal, it can be hard to tell what to be worried about (and given the last post, there are definitely things to be worried about!). It may seem that something will surely happen (you can blame television for that feeling), but in many cases, a patient will be just fine.
Before looking further into the various substances that can cause problems for our young patients, I thought it would be interesting and fun to talk about some of the non-toxic exposures the Poison Information Centre receives calls about – sometimes daily.
When patients and their parents find themselves in front of you, knowing a little about what you needn’t worry about is useful. Or in some cases, only worry about a little…
Topical antiseptics and hand sanitisers
With all this talk about hand hygiene and killing germs, it’s not surprising that someone would worry about someone getting into one of these.
From a Toxicology perspective, two ingredients in these products can be problematic—the first are quaternary ammonium compounds. A prime example is benzalkonium chloride, found in products such as Dettol. The concentrations for most household products are low (less than 7.5%) and likely to cause GI irritation at best, perhaps vomiting and some diarrhoea, so supportive treatment will suffice.
Not surprisingly, deliberate overdoses can be clinically more significant with sequelae including corrosive injury, hypotension, renal injury and aspiration. Hand sanitisers containing alcohol, typically ethanol, can cause intoxication if a large amount is ingested.
In scenarios where a child has had a taste, lick or swallow, significant toxicity is very unlikely.
In the end, Paracelsus still holds – the dose makes the poison, and in most cases, it will not be a problem.
Silica gel packets
Containing sodium silicate to prevent excess moisture build-up and food spoilage, these little white packets are everywhere you look in the pantry. Unsurprisingly, people get worried when they read the warning ‘DO NOT EAT’ all over the packet. Fortunately, silica is non-toxic; however, it can be a choking hazard, so a medical assessment is recommended if there are any signs suggestive of inhalation (e.g. cough, wheezing).
Dish-washing detergents
Dishwashing detergents contain soaps to help remove dirt and grease, but luckily not people. Like other household products, they only cause mild GI upset, a scratchy throat, and aspiration if vomiting occurs.
Toilet bowl cleaners
The usual suspects are the toilet discs (see below). Given that their job is to help clean yucky organic matter from the inside of a toilet, these are rather pretty in appearance.
As a parent, I do not know what would horrify me more – my child putting his finger into a disc or the toilet! Maybe the latter…
These discs contain detergent and perfume, but the exposure method is usually a ‘finger dip’, so minimal exposure occurs. If anything, mild GI upset may occur with a larger ingestion. Important advice for parents is that the next poo might be a more psychedelic colour than usual. Â
Glow sticks
I suspect most calls come around New Year’s or Moomba (if you live in Melbourne). Glow sticks glow thanks to an ester called Cyalume, which luminesces when mixed with hydrogen peroxide.
Some products have a plastic casing that contains an inner glass capsule that, when broken, allows the Cyalume (in the glass capsule) to mix with the hydrogen peroxide (surrounding the capsule).
An accidental chew will lead to a bitter taste, a dry mouth and perhaps vomiting with some nausea but not much else.
Creams and Lotions
While they keep your skin looking healthy and young, eating these will not do much to your insides apart from causing a GI upset. Some of these contain small amounts of ethanol, but normally, not enough to cause clinically significant toxicity.
Perfumes, colognes and after-shaves
Like creams and lotions, these products are often in reach of little hands. Little people often do not drink much, if any, due to their strong odour and taste. Small ingestions are irritants in nature, but larger ingestions can result in ethanol intoxication. However, many of these products can contain 60-80% ethanol, and given the taste, it would be a very rare event for a child to swallow enough to become intoxicated.
As these are volatile products, off-gassing of fumes can occur and cause chemical pneumonitis in larger ingestions, but the taste and smell of these are such that this is a rare occurrence.
Pens/Ink
Suddenly, I find myself back in high school, swinging from my chair in the back row while chatting with friends. The typical patient is a young teenager sucking on a pen. The anticipated adverse effects include discolouration of the tongue, faeces and clothing, often with a sense of embarrassment but nothing more.
Bubbles
Whilst we ask you not to forget about the bubbles, I’m happy to add, ‘Don’t worry about the bubbles’. These often contain soap or mild detergent to produce these clear spheres of pure delight, so a drink from a container will result only in GI upset and perhaps some irritation if other parts of the body make contact (e.g., eyes). Not to be confused with the champagne variety.
Don’t forget to check out the other posts in this series…
Special thanks to Jeff Robinson for his review and input
References
Hammond, K., Graybill, T., Spiess, S. E., Lu, J., & Leikin, J. B. (2009). A complicated hospitalization following dilute ammonium chloride ingestion. Journal of Medical Toxicology, 5(4), 218–222. https://doi.org/10.1007/BF03178271
Joseph, M. M., Zeretzke, C., Reader, S., & Sollee, D. R. (2011). Acute ethanol poisoning in a 6-year-old girl following ingestion of alcohol-based hand sanitizer at school. World Journal of Emergency Medicine, 2(3), 232–233. https://doi.org/10.5847/wjem.j.1920-8642.2011.03.014
Disclaimer: The information in this post is for medical education only and does not constitute formal Toxicology advice. It is current at the time of writing and may change with emerging evidence over time. If you have concerns about an individual who may be poisoned, please call your local Poisons Information Centre (13 11 26 for Australia).