Ryan and Toxo Discuss the History and Risks of a Common Disinfectant

In this episode, Ryan and Toxo dive into the history of a commonly used disinfectant, exploring its dangers when misused. From creating chemical weapons to causing severe injuries, they break down its toxic potential and offer critical safety tips. They break down the many ways it can cause harm if not used appropriately, including creating chemical weapons and turning your body into soap. Finally they review treatment recommendations if you accidentally are exposed, or if you are health care provider treating an exposure.

Key Points

Bleach Reactions with Other Chemicals

1. Bleach + Acid → Chlorine Gas

• Reaction: Cl₂ + H₂O ⇄ HCl + HClO
• Base neutralizes HCl to drive reaction forward; reversed with acid addition.
• Source

1. Bleach + Ammonia → Chloramine Gas

• Chloramine properties: PubChem Link

1. Bleach + Rubbing Alcohol (Isopropyl) → Chloroform
2. Bleach + Soap → Carbon Tetrachloride

Toxic Effects of Chlorine Gas

• Mechanism: High solubility irritant, dissolving in mucous membranes, causing severe irritation in the eyes, nose, and upper airway.
• Symptoms: Effects are noticed quickly and may appear severe initially.
• Treatment:
• Remove from exposure, ensure a patent airway, and provide supportive care.
• Oxygen for hypoxemia.
• Bronchodilators (e.g., albuterol) for airway irritation.
• Nebulized Sodium Bicarbonate may have a role in treating chlorine gas inhalation.
• Systematic Review

Safety Advice

• If exposed to chlorine gas, move to fresh air, open windows, and call 911 or your local poison center.
• Bleach Ingestion: Can cause liquefactive necrosis. Treatment focuses on assessing injury for risk of stricture or esophageal stenting.

Steroid Use in Chemical Inhalation Injuries

• Research Summary:
• Corticosteroids are not routinely recommended due to limited evidence from controlled trials.
• Case reports suggest potential benefit but lack appropriate comparators.
• References:
• Brief summary of steroid use with irritant gases:  Reproduced with permission from : Pape KO, Feldman R. Smoke inhalation and Toxic Exposure. Chapter In: Erstad B, ed. Critical Care Pharmacotherapy. Lenexa: American College of Clinical Pharmacy. January 2020.
• Steroid use in pulmonary irritant induced pneumonitis is not well evaluated in randomized controlled trials. Reviews of animal data suggest no significant benefit for poorly water soluble or high doses of water-soluble irritants. They may also have a negative effect on the recovery phase (deLange 2011).Numerous case reports exist detailing positive outcomes from use of steroids in patients exposed to pulmonary irritants (deLange 2011).However, without an appropriate comparator it is not known if symptom resolution is related to the intervention or the natural progression of the disease. Small human crossover trials evaluating the effects of mild ozone exposure found a reduction in bronchiolar lavage inflammatory markers with inhaled fluticasone or budesonide but no difference in clinical effects (deLange 2011, Nightingale 2000, Alexis 2008, Vagaggini 2001). Due to the absence of well controlled trials, steroids are not routinely recommended for chemical pneumonitis. However, there is also a lack of negative data and institutional protocols or patient specific factors may govern their use.

Historical Context

• Claude Berthollet: Pioneer of chlorine disinfection.
• Biography
• Antoine Labarraque: Innovator in bleach use for sanitation.
• Biography

Additional References

• Caustic Ingestion Review:
• Hoffman RS, Burns MM, Gosselin S. NEJM 2020
• Pulmonary Irritants Overview:
• Nelson LS, Odujebe OA. Goldfrank's Toxicologic Emergencies, 11e.
• Reactions of Sodium Hypochlorite with Other Compounds:
• Odabasi M. Environ Sci Technol 2008
• Chlorine Gas Exposure Management:
• Huynh Tuong A, et al. Clin Toxicol 2019
• Incidence Data:
• Gummin DD, et al. Clin Toxicol 2017

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