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M. Sánchez Martín*, M. Gómez de Pablos Romero**
*Adjunto de Pediatría del Hospital Universitario La Paz. Madrid. **Adjunto de Pediatría de la Clínica Universidad de Navarra. Pamplona
41. Bleach ingestion in the ED
Resident: María Sánchez Martín. Adjunto de Pediatría del Hospital Universitario La Paz. Madrid
Mother: Mónica Gómez de Pablos Romero. Adjunto de Pediatría de la Clínica Universidad de Navarra. Pamplona
Resident: Good morning, I’m Dr. Cole. What brings you here today?
Mother: Good morning Dr. Cole. I’m here with my daughter, Laura, because I think she drank some bleach.
Resident: Alright, stay calm. How old is she? Does she have any previous medical history? When did this happen? Do you know how much she drank? And, was the bleach mixed with any other cleaning product?
Mother: Laura is three years old and healthy. It happened about half an hour ago. I was cleaning the house and I found her in the kitchen with the bottle of bleach without the lid on, it wasn’t mixed with anything else. She tells me she hasn’t drunk any at all, but I’m not sure. The bottle is almost full, though.
Resident: OK. Has she presented vomiting, tummy ache, eye pain or any other symptoms?
Mother: No, she has been fine the whole time. I washed her hands and her face with soap and water before coming to the ED.
Resident: Perfect, let’s take a look at Laura.
PHYSICAL EXAMINATION
Pulse: 87 bpm. BP 95/56 mmHg. Respiratory rate 22 bpm. SpO2 98%. Good general condition. Alert and oriented in all three spheres. Well-nourished and hydrated. Capillary refill time: 2 seconds. No skin lesions. No respiratory distress. Cardiac auscultation: regular, no heart murmur. Pulmonary auscultation: general good bilateral ventilation, no pathological breath sounds. HEENT: normal oropharynx without any visible lesions, no drooling. Normal eye examination, no hyperemia or tearing. Abdomen: soft, nontender to palpation.
Resident: Laura has a normal physical examination; I can see no signs of intoxication or that the bleach has caused any organic damage. Nevertheless, I would like to keep her a couple of hours with us, have her drink some water and see how she goes.
Mother: What could happen?
Resident: She might develop respiratory, gastrointestinal or other symptoms, in which case we would have to consider performing an endoscopy. However, household bleach is usually diluted so it is not expected to cause serious injury.
Mother: And if we go home, is there something we should look out for?
Resident: It would be strange for her to develop new symptoms then, but bring her back in if she has vomiting, abdominal pain, trouble breathing, eye symptoms or any other thing that worries you. For now, remain in the waiting room and have her drink some water. Let me know if anything happens and if not, I will call you in a few hours.
Mother: OK, thank you doctor.
KEY WORDS
Bleach: lejía.
Cleaning product: producto de limpieza.
Lid: tapa.
Drooling (to drool): babear, babeo.
Organic damage: daño orgánico.
Endoscopy: endoscopia.
Household bleach: lejía para uso doméstico.
Diluted: diluido/a.
Waiting room: sala de espera.
Chronic diarrhea 