Laundry Pod Ingestion

Authored by: Dr. Chrissy Zauner

Introduction:
Laundry pod detergents were introduced to the market in the US in 2010. Following this in 2012-2013, the National Poison Data system recorded 17,230 exposures in children younger than the age of 6. The vast majority of ingestions were unintentional due to the candy like design of the pod. Most papers available are case reports, serious outcomes include: superficial partial thickness burns, seizures, respiratory failure requiring intubation. 

Recently, there has been a surge in intentional ingestions among teenagers. “Tide Pod Challenge” It remains unclear how it began, possibly stems from an article on The Onion posted December 2015 written from the viewpoint of a child attempting to eat pods. This was followed by a College Humor video about not eating laundry pods in March 2017. Early January 2018, memes started appearing, followed by YouTube videos. 

Between January 1st-January 22nd, there were 86 cases of intentional ingestion. As of Saturday, February 10, 2018 a YouTube search produces 81,200 video results, both of videos performing the challenge and those against it. YouTube recently announced it would be pulling videos due to the dangers of exposure. 

Pharmocology/Pharmokinetics: Unclear overall

• Propylene glycol: absorbed by GI tract, Vd 0.6L/kg, may be absorbed percutaneously through damaged skin areas, 12-45% excreted unchanged in the urine, otherwise metabolized in the liver
• • WHO maximum allowable intake 25 mg/kg

Metabolic Pathways and Active Metabolites:

• Propylene glycol -> lactaldehyde->lactic acid by alcohol dehydrogenase
  • Then to pyruvate

Toxicity/Mechanism of Toxicity:

• Much more likely to be symptomatic from pod exposure vs regular detergent. Unclear  whether the significant adverse health effects observed with laundry detergent pod exposures relate to unique ingredients, differences in pH or other chemical properties.
• Ethoxylated alcohols may cause gastric irritation and lethargy
• Direct contact may cause irritation of the oropharynx and esophagus
• Aspiration and resulting pulmonary toxicity may occur with or without coincident CNS
  depression and vomiting

​​Propylene Glycol

• Cardiovascular: hypotension, bradycardia, widening of the QRS interval, increased T wave amplitude
• Neurotoxicity: Ethanol and/or PG may contribute to the CNS depression
  o Smaller infants have a decreased ability to clearPG
  o Case studies of seizures in lowbirthweight infants receiving 3g daily in parenteral multivitamins
• Hyperosmolarity, elevated osmolar gap, metabolic acidosis following metabolism
• Nephrotoxicity: rental tubular necrosis
• Is the dose of propylene glycol high enough in Tide Pods to cause significant long term
  damage? Unclear

Clinical Presentation:​

• Vomiting (most common), aspiration risk?
• Coughing or choking
• Respiratory distress
• Altered mental status
• Seizure-like activity
• Eye irritation
• Skin irritation 

Treatment:

• Topical exposure: Irrigation
• Ingestion: Supportive care, airway protection, IVF, oxygen 

​

References:

• Beuhler MC, Gala PK, Wolfe HA, Meaney PA, Henretig FM a case series and discussion of recent literature. Pediatr Emerg Care. 2013;29(6):743–747. 
  
• Bever, L. Teens are daring each other to eat Tide pods. We don't need to tell you that's a bad idea. The Washington Post. January 17, 2018. https://www.washingtonpost.com/news/to-your- health/wp/2018/01/13/teens-are-daring-each-other-to-eat-tide-pods-we-dont-need-to-tell- you-thats-a-bad-idea/?utm_term=.fea447dea690. Accessed February 12, 2018
  
• Centers for Disease Control and Prevention (CDC). Health hazards associated with laundry detergent pods. United States, May-June 2012. MMWR. 2012;61:825Y829.
  
• HERA. Alcohol Ethoxylates. Human & Environmental Risk Assessment on ingredients of European household cleaning products. September 2009. Available at: http://www.heraproject.com/files/34-F-09%20HERA% 20AE%20Report%20Version%202%20- %203%20Sept%2009.pdf. Accessed February 12, 2018.
  
• Proctor and Gamble. MSDS: Tide Pods. https://www.pg.com/productsafety/msds/2014/Tide%20Pods%20MSDS%20July%202014.pdf Accessed Februrary 12, 2018
  
• Proctor and Gamble. SDS: Tide. https://www.pgproductsafety.com/productsafety/sds/SDS_2016/Tide.pdf. Accessed February 12, 2018.
  
• Schneir, A, Rentmeester, L, Clark, R, Canterll, FL. Toxicity Following Laundry Detergent Pod Ingestion. Pediatric Emergency Care. 2013 June; 29(6):741-742. . Laundry detergent “pod” ingestions:
  
• Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA. Pediatric exposure to laundry detergent pods. Pediatrics. 2014 Dec;134(6):1127-35.