SPECIAL NOTE: At The Review Course in Family Medicine, we do our best to accommodate special dietary requests. However, please note our caterers are not able to supply Tide Pods or detergent pods of any other variety.
SNAP SAMP:
A 14-year-old presents to your emergency department brought by friends who announce that your patient has successfully completed the “Tide Pod Challenge” in an effort to increase their number of Instagram followers. After you take a moment to ponder the actual definition of “success,” you begin to assess your patient, who is obtunded, tachypneic and has remarkably brightly-coloured vomitus on their face and shirt.
Other than laboratory investigations and physician consultations, name FIVE immediate steps in managing this patient.
Name THIRTEEN (yes, 13) additional medical specialties and hospital-based professionals that you would consider involving in this case.
You obtain laboratory investigations and your patient has a temperature of 39°C, pH of 7.22, bicarbonate of 15 mmol/L, anion gap of 26, and lactic acid of 9.3 mmol/L. What relevant metabolic derangement do you identify?
Answers are in the blog post below.
Though accidental ingestion of laundry pods has been reported since their release in 2001, nobody could have expected the new soapy trend bubbling up all over the Internet this starting in January 2018: the “Tide Pod Challenge,” or intentional ingestion. Yes, you read that right: intentional. In case you have been studying for the exam and not keeping up with the latest adolescent trends, this month’s “challenge” is based on the theory that because the pods look so juicy and flavorful, people should post videos of themselves biting into the “forbidden fruit.” (Since apparently it needs to be said, do NOT do this.) As it turns out, lather is not the best medicine. So what should you do if your next patient on the exam or in real life has participated in the Tide Pod Challenge? Here’s an acronym to explain the major management steps: S.O.A.P.
Quick and dirty: Mnemonic for Medical Management of Laundry Detergent Pod Ingestion
S – Stabilize & Stop O – Observe & Other Diagnoses A – Ask for help P – Poison control S – Stabilize the patient & stop the ongoing damage ABCs come first and foremost. These pods can cause respiratory distress due to aspiration and reduced level of consciousness, and oropharyngeal burns can occur. Also, stop the ongoing damage by decontaminating – eye irrigation may be required if the contents have splashed into the patient’s eye. O – Observe Take a close look for any of the possible complications. Laundry pods cause more serious injury than non-pod detergents, due to the increased concentration and additional ingredients (such as propylene glycol). They affect multiple systems: gastrointestinal (strictures, burns) respiratory (aspiration, pneumonitis), neurologic (decreased level of consciousness), ophthalmologic (eye burns), dermatologic (skin burns), and metabolic (acidosis). Observation does not end in the emergency department; ensure adequate follow-up. Other diagnoses should also be considered, including a second toxin. Take a look at the extensive differential diagnosis list at WikiEM. A – Ask for help Consider consulting as needed:
Pediatric Emergency medicine
Pediatrics
Pediatric intensive care; intubation may be required and like the patient in the SNAP SAMP, these patients can present with a lactic acid metabolic acidosis (on the exam be sure to be as complete as possible – simply “metabolic acidosis” may be considered insufficient).
Pediatric gastroenterology; endoscopy is often required
Medical Toxicology
Respirology; bronchoscopy has been required in some cases of laundry pod ingestion
Respiratory Therapy
Psychiatry
Counselling
Social work
Child protection services; abuse should be suspected especially if any of the friends are adults
Speech-language pathology; swallowing dysfunction has been reported
Chaplain
Can you name any more management steps or referral options? Reply to this e-mail and we’ll include your answer on our blog posts and a future e-mail update. We’ll list you as anonymous unless you include consent for us to use your name.
P – Poison control, and Prevent the next exposure
Never forget poison control as a management step in any exposure or ingestion. Finally, prevention is an important step in accidental exposure; if the situation calls for it, please tell your patients to not eat soap of any variety.
REFRENCES: