Liquid automatic dishwashing detergents: a profile of toxicity

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.