Sodium hypochlorite poisoning: MedlinePlus Medical Encyclopedia

P Sodium hypochlorite is a chemical commonly found in bleach, water purifiers, and cleaning products.
P Swallowing sodium hypochlorite can lead to poisoning. Breathing sodium hypochlorite fumes may also cause poisoning, especially if the product is mixed with ammonia.
P This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

T Poisonous Ingredient
P Sodium hypochlorite

T Where Found
P Sodium hypochlorite is found in:
- Chemical used to add chlorine to swimming pools
- Disinfectants
- Some bleaching solutions
- Water purifiers
P Note: This list may not be all-inclusive.

T Symptoms
P Watered-down (diluted) sodium hypochlorite generally causes only mild stomach irritation. Swallowing larger amounts can cause more serious symptoms. Industrial-strength bleach contains much higher concentrations of sodium hypochlorite, which may cause severe injury.
P NEVER mix ammonia with sodium hypochlorite (bleach or bleach-containing products). This common household error produces a toxic gas that can cause choking and serious breathing problems.
P Symptoms of sodium hypochlorite poisoning may include:
- Burning, red eyes
- Chest pain
- Coma
- Coughing (from the fumes)
- Delirium
- Gagging sensation
- Low blood pressure
- Pain in the mouth or throat
- Possible burns on the esophagus
- Skin irritation of the exposed area, burns, or blistering
- Shock
- Slow heartbeat
- Stomach or abdominal pain
- Vomiting

T Home Care
P Seek immediate medical help. DO NOT make a person throw up unless told to do so by Poison Control or a health care professional.
P If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.
P If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. DO NOT give water or milk if the person is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.
P If the person breathed in the poison, immediately move him or her to fresh air.

T Before Calling Emergency
P Determine the following information:
- The person's age, weight, and condition
- The name of the product (ingredients and strengths, if known)
- The time it was swallowed
- The amount swallowed
P However, DO NOT delay calling for help if this information is not immediately available.

T Poison Control
P Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This hotline number will let you talk to experts in poisoning. They will give you further instructions.
P This is a free and confidential service. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

T What to Expect at the Emergency Room
P The person will be admitted to a hospital. The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate.
P The person may receive:
- Airway support, including oxygen, breathing tube through the mouth (intubation), and breathing machine (ventilator)
- Blood and urine tests
- Camera down the throat (endoscopy) to see burns in the esophagus and stomach
- Chest x-ray
- EKG (electrocardiogram, or heart tracing)
- Fluids through a vein (IV)
- Medicines to treat symptoms
P Note: Activated charcoal does not effectively treat (adsorb) sodium hypochlorite.
P For skin exposure, treatment may include:
- Irrigation (washing of the skin), possibly every few hours for several days
- Surgical removal of burned skin (skin debridement)
- Transfer to a hospital that specializes in burn care
P The person may need to be admitted to a hospital to continue treatment. Surgery may be needed if the esophagus, stomach, or intestine have holes (perforations) from the acid.

T Outlook (Prognosis)
P Swallowing, smelling, or touching household bleach will likely not cause any significant problems. However, more severe problems can occur with industrial-strength bleach, or from mixing bleach with ammonia.
P How well a person does depends on how rapidly the sodium hypochlorite was diluted and neutralized. There is a good chance of recovery if proper treatment is given soon after the poison was swallowed. Without prompt treatment, extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible, depending on how exposure occurred. Holes (perforation) in the esophagus and stomach may cause serious infections in both the chest and abdominal cavities, which may result in death.

T Alternative Names
P Bleach; Clorox; Carrel-Dakin solution

T References
P Aronson JK. Sodium hypochlorite and hypochlorous acid. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:418-420.
P National Library of Medicine, Specialized Information Services, Toxicology Data Network. Sodium hypochlorite. Toxnet.nlm.nih.gov Web site. Updated March 5, 2003. toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~jUIST3:1. Accessed February 9, 2017.

T Review Date 1/31/2017
P Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

