Detergent Pod Ingestions -Is an Endoscopy Needed?

A recent study (A Singh et al. JPGN 2019; 68: 824-8) provides a descriptive retrospective review of a single center experience with detergent pods (a.k.a. laundry pods or dishwater pods). There is very little published in this area and no clear consensus on management.

For me, the most interesting finding in the study is the discrepancy between the ENT service which only did a direct laryngoscopy-bronchoscopy (DLB) in 6 of 23 (26%) ingestions compared with 21 of 23 (91%) EGD rate among patients who presented to the GI service.

Key findings:

  • Of those undergoing an EGD, 76% were normal; abnormal findings (edema, erythema or ulceration) were present in 24% (though figure 4 suggests erythema in 28%). Ulceration was noted in 14%.
  • In the DLB cohort (n=6), 33% were normal and 67% were abnormal.

Unfortunately, this report has a lot of limitations:

  • It did not provide any information regarding long-term effects (if any were present)
  • It did not provide much guidance in determining whether an EGD is worthwhile. The authors did note that patients with oral injuries were more likely to have an abnormal EGD. 80% of patients with positive oropharyngeal findings had an abnormal EGD compared with 20% with a normal oropharyngeal exam.
  • In the discussion, the authors reference a study which reported esophageal injury in only 0.1% of cases (Davis et al.  2016 May;137(5). pii: e20154529. doi: 10.1542/peds.2015-4529. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014). There were two deaths in this study.

My take: This would have been a good report to have an associated commentary/expert opinion.  Even if an EGD is abnormal, this does not mean that the EGD was needed.  The bigger question is how often an EGD would improve management.  Given the lack of specific treatments, it is likely that an EGD should be reserved for severe cases –which could include the following:

  • intentional ingestions
  • significant oropharyngeal burns
  • food refusal
  • drooling/difficulty managing secretions
  • stridor

Related blog post: New caustic danger from detergent pods

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Detergent Pods -Still an Issue -This Tweet is from June 5, 2019

Cheap Technology for Button Battery Ingestions

Typical Button Battery

Typical Button Battery

An NPR report regarding “the results of .. experiments published Monday in the Proceedings of the National Academy of Sciences show that a prototype shield is effective at keeping small, 11 millimeter batteries from damaging the esophagus after being swallowed.”  This would be worthy endeavor to pursue.  The larger buttons (20 millimeters in diameter) “are particularly dangerous. One out of 8 children [under 6 years old] who swallow this larger battery are going to have a serious debilitating complication.”  Here’s the link: Battery Shield

Here’s an excerpt regarding the shield:

Microscopic metal particles are embedded in the shield, which is a millimeter thick. When a battery is inserted into a device, the pressure from the device’s cover or a spring that holds the battery in place pushes the metal particles together. The shield then acts like a switch, conducting electricity.

When the battery is free, floating down a child’s esophagus, for instance, there’s not enough pressure to make the microparticles smush together. The shield then acts as an insulator…

The shield’s material is commercially available and currently used in touch-screen devices where a gentle press of a fingertip can complete a circuit.

Related blog posts:

 

"Great Power" for Damaging an Esophagus

“Great Power” for Damaging an Esophagus

Review of Button Batteries

A recent open access article reviews button batteries and reiterates algorithm from poison control (noted in previous blog post: Button Battery Algorithm Link | gutsandgrowth).  This article has some excellent figures detailing the extent of the problem and has relevant pictures of radiographs and mucosal damage.

Here’s the reference:

International Journal of Pediatric Otorhinolaryngology 77 (2013) 1392–1399

Here’s the link:

http://authors.elsevier.com/offprints/PEDOT6686/7551db6b14c8aabfa827016d69367c08 …

New caustic danger from detergent pods

“Brightly colored little packets that combine laundry detergent with other cleaning agents are a new convenience for consumers — and a new danger for kids.”

See more complete story at attached links that follow:

http://www.washingtonpost.com/national/poison-control-centers-field-increased-number-of-calls-of-children-ingesting-detergent-packets/2012/05/24/gJQAaiSZnU_story.html

http://yourlife.usatoday.com/health/healthyperspective/post/2012-05-24/new-kid-danger-swallowing-candy-colored-laundry-packets/701134/1