Krenzelok E P
Children's Hospital of Pittsburgh, Pittsburgh Poison Center, Pennsylvania 15213.
Ann Emerg Med. 1989 Jan;18(1):60-3. doi: 10.1016/s0196-0644(89)80315-4.
The recent introduction of liquid automatic dishwashing detergents (LADDs) has resulted in numerous calls to poison information centers and, subsequently, a large number of referrals to emergency departments. As with their traditional granular counterparts, LADDs contain alkaline builders that contribute to the pH of these products. Exposure to granular automatic dishwashing detergents has been associated with caustic injury similar to the pathology produced by other alkaline corrosives. Do LADDs produce similar toxicity? There is no published information that profiles the toxic manifestations associated with exposure to LADDs. To determine their toxicity, all LADD exposures reported to a regional poison information center over a 12-month period were collected. One hundred ninety-two human exposure cases were reviewed. Pediatric patients accounted for 76% of the exposures; 76% were ingestions, 12% were dermal exposures, and 12% were ocular exposures. Seventy-nine percent of the patients were exposed to a full-strength product, and 21% contacted a dilute product or one that had already been through the dishwashing cycle. Of the patients who ingested a LADD, 91.1% remained asymptomatic, 8.2% had minor symptoms, and only one (0.7%) suffered moderate toxicity. In contrast, 91.3% of all patients who had an ocular exposure developed minor or moderate toxicity (73.9% vs 17.4%). Of dermal exposures, 69.6% were asymptomatic, and those with symptoms were the result of inappropriate use. Overall, 78.7% remained asymptomatic, 18.2% developed minor toxicity, and 3.1% developed moderate toxicity. Small oral and dermal exposures usually do not result in toxicity and do not necessitate referral to an ED. Ocular exposures are associated with a high incidence of at least minor toxicity and require ED evaluation.
近期液体自动洗碗机洗涤剂（LADDs）的推出导致大量致电毒物信息中心的情况，随后又有大量患者被转诊至急诊科。与传统颗粒状同类产品一样，LADDs含有碱性助洗剂，这决定了这些产品的pH值。接触颗粒状自动洗碗机洗涤剂会导致苛性损伤，其病理表现与其他碱性腐蚀剂所致相似。LADDs会产生类似的毒性吗？目前尚无公开信息描述与接触LADDs相关的毒性表现。为确定其毒性，收集了某地区毒物信息中心在12个月内报告的所有LADD暴露案例。共审查了192例人体暴露病例。儿科患者占暴露病例的76%；76%为摄入，12%为皮肤暴露，12%为眼部暴露。79%的患者接触的是原液产品，21%接触的是稀释产品或已经过洗碗机循环的产品。在摄入LADD的患者中，91.1%无症状，8.2%有轻微症状，只有1例（0.7%）出现中度毒性。相比之下，所有眼部暴露患者中有91.3%出现轻微或中度毒性（73.9%对17.4%）。皮肤暴露者中，69.6%无症状，有症状者是不当使用所致。总体而言，78.7%无症状，18.2%出现轻微毒性，3.1%出现中度毒性。经口和皮肤小剂量暴露通常不会导致中毒，无需转诊至急诊科。眼部暴露与至少轻微毒性的高发生率相关，需要急诊科评估。
