title: Toxicity of soluble film automatic dishwashing products as reported to the United Kingdom National Poisons Information Service 2008-2015.
abstract: BACKGROUND
  Soluble film automatic dishwashing tablets, unlike their traditional counterparts, require no removal from an outer protective wrapper prior to use. Instead, the tablets are enclosed by a water-soluble polyvinyl alcohol film and are loaded straight into the dishwashing machine. They most commonly contain a source of hydrogen peroxide (often as sodium percarbonate) and non-ionic surfactants. Other constituents in some formulations include sodium carbonate, sodium tripolyphosphate and sodium silicate, which reduce water hardness. The pH once dissolved in water is alkaline.
  
  
  OBJECTIVE
  To determine the toxicity from exposure to soluble film automatic dishwashing tablets.
  
  
  METHODS
  Telephone enquiries to the United Kingdom National Poisons Information Service regarding soluble film automatic dishwashing products were analysed retrospectively for the period January 2008 to December 2015.
  
  
  RESULTS
  There were 498 enquiries relating to 488 patients. Almost all exposures occurred in the home (98.4%) and involved children aged ≤5 years (92.8%). Exposure occurred mainly as a result of ingestion alone (n = 470, 96.3%); eye contact alone (n = 9, 1.8%) and exposures involving multiple routes (ingestion with skin or eye contact; n = 9, 1.8%) made up the remaining cases. The majority of patients were asymptomatic following exposure (n = 325, 67.4%). The most common feature following ingestion was vomiting which occurred in 121 of 474 cases (25.5%) where clinical data were available. Nausea (n = 8, 1.7%) and coughing (n = 6, 1.3%) were also reported; three patients developed stomatitis and another five developed a rash where ingestion alone was considered to be the sole route of exposure. Ocular exposure to the tablet contents resulted in blurred vision, eye pain or conjunctivitis in seven of ten patients.
  
  
  CONCLUSIONS
  Ingestion of a soluble film automatic dishwashing tablet rarely resulted in clinically significant symptoms, which is surprising given the potential hazard of the ingredients. Hence, it seems probable that the amount of material actually ingested was very small or that most was spat out.
authors.affiliation: a NPIS (Birmingham Unit), City Hospital , Birmingham , UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Day
authors.affiliation: b NPIS (Edinburgh Unit), Royal Infirmary , Edinburgh , UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Eddleston
authors.affiliation: c NPIS (Newcastle Unit), Regional Drug and Therapeutics Centre , Newcastle , UK.
authors.forename: Simon H L
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: d NPIS (Cardiff Unit), University Hospital Llandough , Cardiff , UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Thompson
authors.affiliation: a NPIS (Birmingham Unit), City Hospital , Birmingham , UK.
authors.forename: J Allister
authors.initials: JA
authors.lastname: Vale
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000453:epidemiology / Q000209:etiology; D003902:Detergents / Q000737:chemistry / Q000506:poisoning*; D006801:Humans; D006861:Hydrogen Peroxide / Q000737:chemistry / Q000506:poisoning*; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D011039:Poison Control Centers; D012189:Retrospective Studies; D013501:Surface-Active Agents / Q000737:chemistry / Q000506:poisoning*; D006113:United Kingdom; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
chemical_list: D003902:Detergents; D013501:Surface-Active Agents; D006861:Hydrogen Peroxide
keywords: Automatic dishwashing; dishwashing tablet; household products; soluble film