Accidental ingestion of dishwasher detergent by an elderly patient: a case of successful conservative management
DOI:
https://doi.org/10.4081/ecj.2025.14278Keywords:
Caustic ingestion, mediastinitis, esophageal perforation, intoxication, toxicityAbstract
Accidental ingestion of household cleaning products is a common reason for visits to the emergency department. The broad spectrum of clinical symptoms, along with a higher prevalence in vulnerable patients, complicates the correct management of these cases. We present the case of a 91-year-old man with dementia who was admitted after accidentally ingesting dishwasher detergent. He complained of chest pain and a sensation of upper airway obstruction. Initially, the patient’s vital signs were stable, and radiological imaging results were negative, but his condition quickly deteriorated, leading to esophageal perforation complicated by mediastinitis. The patient was managed by a multidisciplinary team that included emergency physicians, otolaryngologists, toxicologists, endoscopists, and surgeons with a good outcome. This case demonstrates how a coordinated, multidisciplinary strategy, coupled with careful monitoring, can lead to a successful conservative treatment outcome in an elderly patient with numerous comorbidities and a complex medication regimen.
Downloads
References
1. Levine M, Finkelstein Y, Trautman WJ, et al. Is EGD needed in all patients after suicidal or exploratory caustic ingestions? J Med Toxico 2024;20:256-62. DOI: https://doi.org/10.1007/s13181-024-01003-2
2. Arıcı MA, Ozdemir D, Oray NC, et al. Evaluation of caustics and household detergents exposures in an emergency service. Hum Exp Toxicol 2012;31:533-8. DOI: https://doi.org/10.1177/0960327111412803
3. Puiguriguer Ferrando J, Miralles Corrales S, Frontera Juan G, et al. Poisoning among the elderly. Rev Clin Esp 2021;221:441-7. DOI: https://doi.org/10.1016/j.rceng.2020.08.004
4. Aldy K, Du T, Weaver MM, et al. Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020. Clin Toxicol 2022;60:1039-43. DOI: https://doi.org/10.1080/15563650.2022.2074856
5. Wightman R, Read KB, Hoffman RS. Evidence-based management of caustic exposures in the emergency department. Emerg Med Pract 2016;18:1-17.
6. Davis MG, Casavant MJ, Spiller HA, et al. Pediatric exposures to laundry and dishwasher detergents in the United States: 2013-2014. Pediatrics 2016;137:2015-4529. DOI: https://doi.org/10.1542/peds.2015-4529
7. Celentano A, Bissoli M, Sesana F, Scaglione F. Why are adults exposed to liquid laundry detergent capsules? Clin Toxicol 2023;61:999-1000. DOI: https://doi.org/10.1080/15563650.2023.2276037
8. Gumaste VV, Dave PB Ingestion of corrosive substances by adults American. J Gastroenterol 1992;87:1-5.
9. Day R, Eddleston M, Thomas SHL, et al. Exposures to traditional automatic dishwashing tablets and a comparison with exposures to soluble film tablets reported to the United Kingdom National Poisons Information Service 2008-2015.Clin Toxicol 2017;55:206-212 DOI: https://doi.org/10.1080/15563650.2016.1264588
10. Day R, Bradberry SM, Thomas SHL, Vale JA. Liquid laundry detergent capsules (PODS): a review of their composition and mechanisms of toxicity, and of the circumstances, routes, features, and management of exposure. Clin Toxicol 2019;57:1053-63. DOI: https://doi.org/10.1080/15563650.2019.1618466
11. ASGE Standards of Practice Committee. The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 2012;76:1087-94. DOI: https://doi.org/10.1016/j.gie.2012.08.004
12. Chirica M, Kelly MD, Siboni S, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019;31:14-26. DOI: https://doi.org/10.1186/s13017-019-0245-2
13. Schmidt SC, Strauch S, Rosch T, et al. Management of esophageal perforations. Surg Endosc 2010;24:2809-13. DOI: https://doi.org/10.1007/s00464-010-1054-6
14. Müller D, Desel H. Common causes of poisoning: etiology, diagnosis and treatment Dtsch Arztebl Int 2013;110:690-9. DOI: https://doi.org/10.3238/arztebl.2013.0690
15. Shannon MW. Emergency Management of Poisoning Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose; 2007.
16. Sani R, Zabeirou A, Salha I, et al. Results of emergency management of esophageal lesions related to caustic ingestion in children in the emergency department of the General Reference Hospital of Niamey (Niger). Med Trop Sante Int 2024;4.
17. Usta M, Erkan T, Cocugras FC, et al. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014;133:1518-24. DOI: https://doi.org/10.1542/peds.2013-3331
18. Hoffman RS, Burns MM, Gosselin S. Ingestion of caustic substances. N Engl J Med 2020;382:1739-48. DOI: https://doi.org/10.1056/NEJMra1810769
19. Thomson M, Tringali A, Dumonceau JM et al. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017;64:133-53. DOI: https://doi.org/10.1097/MPG.0000000000001408
20. Chirica M, Bonavina L, Kelly MD, et al. Caustic ingestion. Lancet 2017;389:2041-52. DOI: https://doi.org/10.1016/S0140-6736(16)30313-0
Downloads
Published
License
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
