Which nursing intervention is appropriate when treating a child that has consumed dishwasher detergent?

Exposure to automatic dishwashing detergents (ADDs) is common. In 2016, US poison control centers handled over 18,000 exposures involving ADDs; the majority of cases were curious toddlers exploring their environment.

Automatic dishwashing detergents are available in many forms: powder or granules, liquid/gel, unit-of-use tablets (powder blocks), and pods. ADDs have specific ingredients that make them different from hand dishwashing detergents, including strong alkalis, corrosion inhibitors that protect the metal parts of the dishwasher, enzymes that break down food, perfumes that help mask food odors, and foam suppressors so that too much foam does not interfere with the cleaning action.

The same ingredients that make ADDs so effective against fats, proteins, and other types of food grime also make them dangerous if they are swallowed, inhaled, or come into contact with eyes or skin. These special qualities of ADDs make them strong irritants capable of causing chemical burns. Whether someone swallows some ADD, gets it on their skin or eyes, or inhales it, the resulting effects depend on three important factors: the product itself, the amount, and the duration of exposure.

ADDs are alkaline and have a pH of at least 10-11 (neutral pH, or the pH of pure water, is around 7). Their alkalinity gives them the corrosive action against food grime, but also makes them capable of causing tissue injury and burns (see Caution with Caustics from The Poison Post®). Liquid ADDs tend to cause the most injury when compared to powders and tablets. This is because their pH tends to be higher, sometimes as high as 13, making them more likely to cause chemical burns ranging from mild irritation to significant tissue damage. Powder/granular ADDs can cause mechanical injury in additional to chemical irritation. Their gritty texture can scratch the surface of the eye.

The amount or "dose" is also important in whether a person who is exposed to an ADD will have no symptoms, mild symptoms, or severe effects. The majority of exposures are unintentional and by children who are curious and exploring their environment. It is common for kids to get hold of an ADD from the dishwasher itself. The dishwasher door, where the dispenser usually sits, is at eye level and accessible for a crawling child. Luckily, most unintentional ingestions tend to be very small, probably because ADDs have strong, unpleasant tastes. A lick or taste is unlikely to cause anything beyond a little icky taste in the mouth. Nausea and vomiting are very common from a sip or swallow or two.

Finally, the duration of exposure also contributes to the outcome. Don't let a corrosive liquid or powder sit on your skin or in your eye for a long time. Time allows the product to penetrate the tissue and eat away at it. The longer the duration - the more severe the injury, regardless of whether the pH of the ADD is 10 or 13.

If swallowed, ADDs can irritate the mouth, throat, and stomach resulting in a bad taste, throat burning, or nausea and vomiting. Severe outcomes, such as severe burns and swelling of the throat, food pipe, and stomach can also result from swallowing an ADD, depending on the type and amount. Someone might choke when they swallow an ADD, causing some of it to slip into the airway resulting in symptoms such as coughing, chest pain, wheezing, and shortness of breath.

If an ADD touches the eye, it can cause discomfort and pain, redness, tearing, and sometimes a scratch or burn on the surface of the eye. If left on the skin for a prolonged time, ADDs can cause skin burns of varying degrees resulting in redness and pain, peeling, and blistering.

If someone has swallowed an ADD, do NOT make them vomit! Rinse the mouth with water by swishing and spitting a few times. If it just happened, offer sips of water to drink. This will help dilute the product in the stomach, making it less irritating. If an ADD products gets in the eye or on the skin, immediately rinse gently with cool or comfortable-temperature water. Then, get help from Poison Control by checking the webPOISONCONTROL® online tool or calling Poison Control at 1-800-222-1222.

Serkalem Mekonnen, RN, BSN, MPH
Certified Specialist in Poison Information