title: 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.
abstract: BACKGROUND
  Traditional automatic dishwashing tablets are contained within an external wrapper that requires removal prior to use.
  
  
  OBJECTIVE
  To determine the toxicity of traditional tablets and to compare this with our previously reported experience of soluble film dishwashing tablets.
  
  
  METHODS
  Telephone enquiries regarding traditional tablets were analysed retrospectively for the period January 2008 to December 2015.
  
  
  RESULTS
  Traditional tablets: There were 503 enquiries relating to 492 patients who had been exposed to a traditional tablet. Most involved children aged 5 years or less (87.4%). The majority (78.6%) of patients did not develop symptoms after exposure; 21.1% developed minor (PSS 1) symptoms while one patient developed moderate features. Exposure occurred predominantly as a result of ingestion (n = 476, 96.7%); the most common feature in symptomatic patients (n = 99, 20.8%) was vomiting (70 [14.7%] cases). Significantly (p < 0.0001) more adults (44.9% of 49 adults; 95% CI = 31.9-58.7) were reported with features than children (18.2% of 434; 95% CI = 14.9-22.1). There were five cases of eye contact which resulted in eye pain in two patients and eye irritation in another. Only one of 11 patients exposed dermally developed features (a rash around the mouth). Comparison with soluble film exposures: The percentage of patients that were reported with clinical symptoms following ingestion of a soluble film dishwashing tablet (31.7% of 473 patients; 95% CI = 27.7-36.0) was significantly greater (p < 0.0001) than that for a traditional tablet (20.9% of 483 patients; 95% CI = 17.5-24.8). Vomiting was the most commonly reported feature and occurred significantly (p < 0.0001) more frequently amongst patients who had ingested a soluble film tablet (25.5%; 95% CI = 21.8-29.6) than a traditional tablet (14.7%; 95% CI = 11.8-18.1).
  
  
  CONCLUSIONS
  Exposure to both traditional and soluble film tablets only rarely produced clinically significant symptoms (PSS ≥2). However, ingestion of a soluble film tablet was significantly more likely to result in clinical features than ingestion of a traditional tablet.
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; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003902:Detergents / Q000506:poisoning*; D005131:Eye Injuries / Q000139:chemically induced; D006795:Household Products / Q000506:poisoning*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011039:Poison Control Centers; D012189:Retrospective Studies; D012871:Skin Diseases / Q000139:chemically induced; D012995:Solubility; D013607:Tablets; D006113:United Kingdom / Q000453:epidemiology; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D003902:Detergents; D013607:Tablets
keywords: Automatic dishwashing tablets; dishwashing tablet; household products; soluble film tablet; traditional tablet