Concentrated detergent pods are a cause of caustic ingestions in young children due to their similar appearance to candy. The authors of this study attempted to describe both endoscopy as well as bronchoscopy findings in children who had injuries from detergent pods by reviewing concentrated detergent pod ingestions occurring at a single, tertiary children’s hospital over 7 years (2010-2016). This retrospective study included children between 0 to 18 years of age who were exposed to caustic agents, including concentrated detergent pods. Children were excluded if they had a pre-existing disease of the esophagus (such as gastroesophageal reflux disease) or if they had a concurrent foreign body ingestion occurring with a caustic ingestion. Patient demographics, including esophagogastroduodenoscopy (EGD) and direct laryngoscopy-bronchoscopy findings were reviewed.
In total, 83 caustic ingestions occurred during this time period, and 23 of these cases (28%) were due to detergent pod ingestion. Detergent pod ingestions mainly occurred in males (61%), and most patients had gastrointestinal symptoms after ingestion (91%). The most common laboratory abnormality was metabolic acidosis which occurred in 39% of patients. Although no gastrointestinal complications such as esophageal stricturing occurred, 13% of patients had respiratory failure requiring intubation / mechanical ventilation. EGD was performed in 91% of patients with detergent pod ingestion, and 30% of these patients had esophageal edema, erythema, or ulcerations. There was a significant association between positive oral-pharyngeal findings and esophageal damage. Direct laryngoscopy-bronchoscopy was performed in 26% of the patient cohort, and damage to the upper airway was noted in 67% of such patients, including epiglottitis and glottis edema although there was no association between respiratory symptoms and airway findings.
Although this is a small study, the results suggest that EGD may not be necessary in children who undergo accidental concentrated detergent pod ingestion. On the other hand, it appears that respiratory failure is a risk and should be considered when such children present in the emergency room, hospital, or clinic setting.
Singh A, Anderson M, Altaf M. Clinical and endoscopy findings in children with accidental exposure to concentrated detergent pods. Journal of Pediatric Gastroenterology and Nutrition 2019; 68: 824-828.