title: Airway compromise in children exposed to single-use laundry detergent pods: a poison center observational case series.
abstract: BACKGROUND
  Single-use laundry detergent pods (LDPs) were introduced to the United States in 2010 but had been available in Europe as early as 2001. Case reports of unintentional exposures noted vomiting, ocular injuries, respiratory depression, and central nervous system depression. We summarize clinical effects from unintentional LDP exposures reported to a single poison center over 15 months.
  
  
  METHODS
  Electronic poison center records were searched using verbatim field and both product and generic codes to identify laundry pod exposures from January 1, 2012, through April 9, 2013. Clinical effects were abstracted to a database and summarized using descriptive statistics.
  
  
  RESULTS
  We identified 131 cases between March 2012 and April 2013. Median (interquartile range) age was 2.0 (1.5) years with 4 adult cases; all were coded as unintentional. The most common route was ingestion (120) followed by ocular (14) and dermal (6). Some patients had multiple routes of exposure. Of ingestion exposures, 79 (66%) were managed at home; and 41 (34%) were evaluated in a hospital, of which 9 patients were admitted. The median (interquartile range) age of admitted patients was 1.4 (1.1) years. Relevant findings in these admitted children included emesis (78%), central nervous system depression (22%), upper airway effects (56%), lower respiratory symptoms (33%), seizure (n = 1), and intubation (67%). One child with emesis initially managed at home was subsequently intubated for respiratory distress.
  
  
  CONCLUSIONS
  Exposure to LDP can cause significant toxicity, particularly in infants and toddlers. Compared to traditional detergents, clinicians should be aware of the potential for airway compromise following exposure to LDP.
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Stromberg
authors.affiliation: Virginia Poison Center, Richmond, VA.
authors.forename: Michele H
authors.initials: MH
authors.lastname: Burt
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: S Rutherfoord
authors.initials: SR
authors.lastname: Rose
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: Kirk L
authors.initials: KL
authors.lastname: Cumpston
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Emswiler
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA. Electronic address: bwills@mcvh-vcu.edu.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Wills
mesh_terms: D002493:Central Nervous System Diseases / Q000139:chemically induced*; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003902:Detergents / Q000506:poisoning*; D004435:Eating; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011039:Poison Control Centers; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*; D012140:Respiratory Tract Diseases / Q000139:chemically induced; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced*; D014768:Virginia; D014839:Vomiting / Q000139:chemically induced*
chemical_list: D003902:Detergents