Medical Management Guidelines
(MMGs) |
for |
Calcium Hypochlorite |
(CaCl2O2) |
Sodium Hypochlorite |
(NaOCl) |
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CAS#
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Calcium Hypochlorite 7778-54-3
Sodium Hypochlorite 7681-52-9 |
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UN# |
Calcium Hypochlorite 1748
Sodium Hypochlorite 1791 |
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Synonyms of calcium hypochlorite include
Losantin, hypochlorous acid, calcium salt, BK powder, Hy-Chlor,
chlorinated lime, lime chloride, chloride of lime, calcium
oxychloride, HTH, mildew remover X-14, perchloron, and pittchlor.
Synonyms of sodium hypochlorite include
Clorox, bleach, liquid bleach, sodium oxychloride, Javex,
antiformin, showchlon, chlorox, B-K, Carrel-dakin solution,
Chloros, Dakin's solution, hychlorite, Javelle water, Mera
Industries 2MOm³B, Milton, modified dakin's solution,
Piochlor, and 13% active chlorine.
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- Persons contaminated with calcium hypochlorite dust, or
whose clothing or skin is soaked with industrial-strength
hypochlorite solutions may be corrosive to rescuers and
may release harmful vapor. Individuals exposed only to gases
released by hypochlorite pose little risk of secondary contamination
to others.
- Calcium hypochlorite is generally available as a white
powder, pellets, or flat plates; sodium hypochlorite is
usually a greenish yellow, aqueous solution. Although not
flammable, they may react explosively. Calcium hypochlorite
decomposes in water to release chlorine and oxygen; sodium
hypochlorite solutions can react with acids or ammonia to
release chlorine or chloramine. Odor may not provide an
adequate warning of hazardous concentrations.
- Both hypochlorites are toxic by the oral and dermal routes
and can react to release chlorine or chloramine which can
be inhaled. The toxic effects of sodium and calcium hypochlorite
are primarily due to the corrosive properties of the hypochlorite
moiety. Systemic toxicity is rare, but metabolic acidosis
may occur after ingestion.
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General
Information |
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Description |
Calcium hypochlorite is generally available
as a white powder, pellets, or flat plates. It decomposes
readily in water or when heated, releasing oxygen and chlorine.
It has a strong chlorine odor, but odor may not provide
an adequate warning of hazardous concentrations. Calcium
hypochlorite is not flammable, but it acts as an oxidizer
with combustible material and may react explosively with ammonia,
amines, or organic sulfides. Calcium hypochlorite should be
stored in a dry, well ventilated area at a temperature below
120ºF (50ºC) separated from acids, ammonia, amines,
and other chlorinating or oxidizing agents.
Sodium hypochlorite is generally sold
in aqueous solutions containing 5 to 15% sodium hypochlorite,
with 0.25 to 0.35% free alkali (usually NaOH) and 0.5 to 1.5%
NaCl. Solutions of up to 40% sodium hypochlorite are available,
but solid sodium hypochlorite is not commercially used. Sodium
hypochlorite solutions are a clear, greenish yellow liquid
with an odor of chlorine. Odor may not provide an adequate
warning of hazardous concentrations. Sodium hypochlorite
solutions can liberate dangerous amounts of chlorine or chloramine
if mixed with acids or ammonia. Anhydrous sodium hypochlorite
is very explosive. Hypochlorite solutions should be stored
at a temperature not exceeding 20ºC away from acids in
well-fitted air-tight bottles away from sunlight.
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Routes of Exposure |
Inhalation |
Hypochlorite solutions can liberate toxic
gases such as chlorine. Chlorine's odor or irritant properties
generally provide adequate warning of hazardous concentrations.
However, prolonged, low-level exposures, such as those that
occur in the workplace, can lead to olfactory fatigue and
tolerance of chlorine's irritant effects. Chlorine is heavier
than air and may cause asphyxiation in poorly ventilated,
enclosed, or low-lying areas.
Children exposed to the same levels of
gases as adults may receive a larger dose because they have
greater lung surface area:body weight ratios and higher minute
volumes:weight ratios. Children may be more vulnerable to
corrosive agents than adults because of the smaller diameter
of their airways. In addition, they may be exposed to higher
levels than adults in the same location because of their short
stature and the higher levels of chlorine found nearer to
the ground.
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Skin/Eye Contact |
Direct contact with hypochlorite solutions,
powder, or concentrated vapor causes severe chemical burns,
leading to cell death and ulceration.
Because of their relatively larger surface
area:weight ratio, children are more vulnerable to toxicants
affecting the skin.
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Ingestion |
Ingestion of hypochlorite solutions causes
vomiting and corrosive injury to the gastrointestinal tract.
Household bleaches (3 to 6% sodium hypochlorite) usually cause
esophageal irritation, but rarely cause strictures or serious
injury such as perforation. Commercial bleaches may contain
higher concentrations of sodium hypochlorite and are more
likely to cause serious injury. Metabolic acidosis is rare,
but has been reported following the ingestion of household
bleach. Pulmonary complications resulting from aspiration
may also be seen after ingestion.
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Sources/Uses |
Sodium and calcium hypochlorite are manufactured
by the chlorination of sodium hydroxide or lime. Sodium and
calcium hypochlorite are used primarily as oxidizing and bleaching
agents or disinfectants. They are components of commercial
bleaches, cleaning solutions, and disinfectants for drinking
water and waste water purification systems and swimming pools
(Teitelbaum 2001).
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Standards and Guidelines |
AIHA WEEL:
STEL (15-min) = 2 mg/m³
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Physical Properties
- Calcium Hypochlorite |
Description: White powder, pellets
or flat plates
Warning properties: Chlorine odor;
inadequate warning of hazardous concentrations
Molecular weight: 142.98 daltons
Boiling point (760 mm Hg): Decomposes
at 100ºC (HSDB 2001)
Freezing point: Not applicable
Specific gravity: 2.35 (water
= 1)
Water solubility: 21.4% at 76ºF
(25ºC)
Flammability: not flammable
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Physical Properties
- Sodium Hypochlorite |
Description: Clear greenish yellow
liquid
Warning properties: Chlorine odor;
inadequate warning of hazardous concentrations
Molecular weight: 74.44 daltons
Boiling point (760 mm Hg): Decomposes
above 40ºC (HSDB 2001)
Freezing point: 6ºC (21ºF)
Specific gravity: 1.21 (14% NAOCl
solution) (water=1)
Water solubility: 29.3 g/100 g
at 32ºF (0ºC)
Flammability: not flammable
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Incompatibilities |
Calcium or sodium hypochlorite react
explosively or form explosive compounds with many common substances
such as ammonia, amines, charcoal, or organic sulfides
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Health
Effects |
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- Hypochlorite powder, solutions, and vapor are irritating
and corrosive to the eyes, skin, and respiratory tract.
Ingestion and skin contact produces injury to any exposed
tissues. Exposure to gases released from hypochlorite may
cause burning of the eyes, nose, and throat; cough as well
as constriction and edema of the airway and lungs can occur.
- Hypochlorite produces tissue injury by liquefaction necrosis.
Systemic toxicity is rare, but metabolic acidosis may occur
after ingestion.
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Acute Exposure |
The toxic effects of sodium and calcium
hypochlorite are primarily due to the corrosive properties
of the hypochlorite moiety. Hypochlorite causes tissue damage
by liquefaction necrosis. Fats and proteins are saponified,
resulting in deep tissue destruction. Further injury is caused
by thrombosis of blood vessels. Injury increases with hypochlorite
concentration and pH. Symptoms may be apparent immediately
or delayed for a few hours. Calcium hypochlorite decomposes
in water releasing chlorine gas. Sodium hypochlorite solutions
liberate the toxic gases chlorine or chloramine if mixed with
acid or ammonia (this can occur when bleach is mixed with
another cleaning product). Thus, exposure to hypochlorite
may involve exposure to these gases.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
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Gastrointestinal |
Pharyngeal pain is the most common symptom
after ingestion of hypochlorite, but in some cases (particularly
in children), significant esophagogastric injury may not have
oral involvement. Additional symptoms include dysphagia, stridor,
drooling, odynophagia, and vomiting. Pain in the chest or
abdomen generally indicates more severe tissue damage. Respiratory
distress and shock may be present if severe tissue damage
has already occurred. In children, refusal to take food or
drink liquid may represent odynophagia.
Ingestion of hypochlorite solutions or
powder can also cause severe corrosive injury to the mouth,
throat, esophagus, and stomach, with bleeding, perforation,
scarring, or stricture formation as potential sequelae.
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Dermal |
Hypochlorite irritates the skin and can
cause burning pain, inflammation, and blisters. Damage may
be more severe than is apparent on initial observation and
can continue to develop over time.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxins
affecting the skin.
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Ocular |
Contact with low concentrations of household
bleach causes mild and transitory irritation if the eyes are
rinsed, but effects are more severe and recovery is delayed
if the eyes are not rinsed. Exposure to solid hypochlorite
or concentrated solutions can produce severe eye injuries
with necrosis and chemosis of the cornea, clouding of the
cornea, iritis, cataract formation, or severe retinitis.
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Respiratory |
Ingestion of hypochlorite solutions may
lead to pulmonary complications when the liquid is aspirated.
Inhalation of gases released from hypochlorite solutions may
cause eye and nasal irritation, sore throat, and coughing
at low concentrations. Inhalation of higher concentrations
can lead to respiratory distress with airway constriction
and accumulation of fluid in the lungs (pulmonary edema).
Patients may exhibit immediate onset of rapid breathing, cyanosis,
wheezing, rales, or hemoptysis. Pulmonary injury may occur
after a latent period of 5 minutes to 15 hours and can lead
to reactive airways dysfunction syndrome (RADS), a chemical
irritant-induced type of asthma.
Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. Children may also be more vulnerable to gas exposure
because of increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
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Metabolic |
Metabolic acidosis has been reported
in some cases after ingestion of household bleach.
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Potential Sequelae |
Exposure to toxic gases generated from
hypochlorite solutions can lead to reactive airways dysfunction
syndrome (RADS), a chemical irritant-induced type of asthma.
Chronic complications following ingestion of hypochlorite
include esophageal obstruction, pyloric stenosis, squamous
cell carcinoma of the esophagus, and vocal cord paralysis
with consequent airway obstruction.
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Chronic Exposure |
Chronic dermal exposure to hypochlorite
can cause dermal irritation.
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Carcinogenicity |
The International Agency for Research
on Cancer has determined that hypochlorite salts are not classifiable
as to their carcinogenicity to humans.
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Reproductive and
Developmental Effects |
No information was located regarding
reproductive or developmental effects of calcium or sodium
hypochlorite in experimental animals or humans. Calcium and
sodium hypochlorite are not included in Reproductive and
Developmental Toxicants, a 1991 report published by the
U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences.
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Prehospital
Management |
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- Rescue personnel are at low risk of secondary contamination
from victims who have been exposed only to gases released
from hypochlorite solutions. However, clothing or skin soaked
with industrial-strength bleach or similar solutions may
be corrosive to rescuers and may release harmful gases.
- Ingestion of hypochlorite solutions may cause pain in
the mouth or throat, dysphagia, stridor, drooling, odynophagia,
and vomiting. Hypochlorite irritates the skin and can cause
burning pain, inflammation, and blisters. Acute exposure
to gases released from hypochlorite solutions can cause
coughing, eye and nose irritation, lacrimation, and a burning
sensation in the chest. Airway constriction and noncardiogenic
pulmonary edema may also occur.
- There is no specific antidote for hypochlorite poisoning.
Treatment is supportive.
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Hot Zone |
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
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Rescuer Protection |
Hypochlorite is irritating to the skin
and eyes and in some cases may release toxic gases.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response to situations that involve exposure to potentially
unsafe levels of chlorine gas.
Skin Protection: Chemical-protective
clothing should be worn due to the risk of skin irritation
and burns from direct contact with solid hypochlorite or concentrated
solutions.
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ABC Reminders |
Quickly establish a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
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Victim Removal |
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management in victims
with chemically-induced acute disorders, especially children
who may suffer separation anxiety if separated from a parent
or other adult.
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Decontamination
Zone |
Victims exposed only to chlorine gas
released by hypochlorite who have no skin or eye irritation
do not need decontamination. They may be transferred immediately
to the Support Zone. All others require decontamination as
described below.
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Rescuer Protection |
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
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ABC Reminders |
Quickly establish a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
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Basic Decontamination |
Rapid decontamination is critical.
Victims who are able may assist with their own decontamination.
Remove and double-bag contaminated clothing and personal belongings.
Flush exposed skin and hair with copious
amounts of plain tepid water. Use caution to avoid hypothermia
when decontaminating victims, particularly children or the
elderly. Use blankets or warmers after decontamination as
needed.
Irrigate exposed or irritated eyes with
saline, Ringer's lactate, or D5W for at least 20
minutes. Eye irrigation may be carried out simultaneously
with other basic care and transport. Remove contact lenses
if it can be done without additional trauma to the eye. If
a corrosive material is suspected or if pain or injury is
evident, continue irrigation while transferring the victim
to the support zone.
In cases of ingestion, do not induce
emesis or offer activated charcoal.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of water or milk; if
the victim is symptomatic, delay decontamination until other
emergency measures have been instituted. Dilutants are contraindicated
in the presence of shock, upper airway obstruction, or in
the presence of perforation.
Consider appropriate management of chemically
contaminated children at the exposure site. Provide reassurance
to the child during decontamination, especially if separation
from a parent occurs.
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Transfer to Support
Zone |
As soon as basic decontamination is complete,
move the victim to the Support Zone.
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Support Zone |
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination or have been exposed only
to vapor pose no serious risks of secondary contamination
to rescuers. In such cases, Support Zone personnel require
no specialized protective gear.
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ABC Reminders |
Quickly establish a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible. Administer supplemental oxygen
as required and establish intravenous access if necessary.
Place on a cardiac monitor, if available.
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Additional Decontamination |
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis or offer activated charcoal.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of water or milk; if
the victim is symptomatic, delay decontamination until other
emergency measures have been instituted. Dilutants are contraindicated
in the presence of shock, upper airway obstruction, or in
the presence of perforation.
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Advanced Treatment |
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. Avoid
blind nasotracheal intubation or use of an esophageal obturator:
only use direct visualization to intubate. When the patient's
condition precludes endotracheal intubation, perform cricothyrotomy
if equipped and trained to do so.
Treat patients who have bronchospasm
with an aerosolized bronchodilator such as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or who have cardiac arrhythmias should
be treated according to advanced life support (ALS) protocols.
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Transport to Medical
Facility |
Only decontaminated patients or those
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If a chemical has been ingested, prepare
the ambulance in case the victim vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate vomitus.
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Multi-Casualty Triage |
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients who have ingested hypochlorite,
or who show evidence of significant exposure to hypochlorite
or chlorine (e.g., severe or persistent cough, dyspnea or
chemical burns) should be transported to a medical facility
for evaluation. Patients who have minor or transient irritation
of the eyes or throat may be discharged from the scene after
their names, addresses, and telephone numbers are recorded.
They should be advised to seek medical care promptly if symptoms
develop or recur (see Patient Information Sheet below).
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Emergency
Department Management |
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- Hospital personnel are at low risk of secondary contamination
from victims who have been exposed only to gases released
from hypochlorite solutions. However, clothing or skin soaked
with industrial-strength bleach or similar solutions may
be corrosive to rescuers and may release harmful gases.
- Ingestion of hypochlorite solutions may cause pain in
the mouth or throat, dysphagia, stridor, drooling, odynophagia,
and vomiting. Hypochlorite irritates the skin and can cause
burning pain, inflammation, and blisters. Acute exposure
to gases released from hypochlorite solutions can cause
coughing, eye and nose irritation, lacrimation, and a burning
sensation in the chest. Airway constriction and noncardiogenic
pulmonary edema may also occur.
- There is no specific antidote for hypochlorite poisoning.
Treatment requires supportive care.
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Decontamination
Area |
Unless previously decontaminated, all
patients suspected of contact with hypochlorite and all victims
with skin or eye irritation require decontamination as described
below. Patients exposed only to chlorine gas who have no skin
or eye irritation may be transferred immediately to the Critical
Care Area. Because hypochlorite is an irritant, don butyl
rubber gloves and apron before treating patients.
Be aware that use of protective equipment
by the provider may cause anxiety, particularly in children,
resulting in decreased compliance with further management
efforts.
Because of their relatively larger surface
area:weight ratio, children are more vulnerable to toxicants
affecting the skin. Also, emergency department personnel should
examine children's mouths because of the frequency of hand-to-mouth
activity among children.
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ABC Reminders |
Evaluate and support airway, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. In cases of respiratory compromise secure airway
and respiration via endotracheal intubation. If not possible,
surgically secure an airway.
Treat patients who have bronchospasm
with an aerosolized bronchodilator such as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
in the conventional manner.
Metabolic acidosis can be managed with
intravenous sodium bicarbonate and buffer solutions.
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Basic Decontamination |
Patients who are able may assist with
their own decontamination. Remove and double bag contaminated
clothing and personal belongings.
Flush exposed skin and hair with copious
amounts of plain water. Use caution to avoid hypothermia when
decontaminating victims, particularly children or the elderly.
Use blankets or warmers after decontamination as needed.
Irrigate exposed or irritated eyes with
saline, Ringer's lactate, or D5W for at least 20
minutes. Remove contact lenses if it can be done without additional
trauma to the eye. Continue irrigation while transporting
the patient to the Critical Care Area.
In cases of ingestion, do not induce
emesis or offer activated charcoal.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of water or milk. Dilutants
are contraindicated in the presence of shock, upper airway
obstruction, or in the presence of perforation.
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Critical Care Area |
Be certain that appropriate decontamination
has been carried out (see Decontamination Area above).
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ABC Reminders |
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children may be
more vulnerable to corrosive agents than adults because of
the smaller diameter of their airways. Establish intravenous
access in seriously ill patients if this has not been done
previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
in the conventional manner.
Metabolic acidosis can be managed with
intravenous sodium bicarbonate and buffer solutions.
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Inhalation Exposure |
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. Treat patients
who have bronchospasm with an aerosolized bronchodilator such
as albuterol.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
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Skin Exposure |
If concentrated hypochlorite solutions
contact the skin, chemical burns may occur; treat as thermal
burns. Patients developing dermal hypersensitivity reactions
may require treatment with systemic or topical corticosteroids
or antihistamines.
Because of their relatively larger surface
area:body weight ratio children are more vulnerable to toxicants
that affect the skin.
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Eye Exposure |
Irrigate exposed or irritated eyes with
saline, Ringer's lactate, or D5W for at least 20
minutes. Check the pH of the conjunctiva every 30 minutes
for 2 hours after irrigation is stopped. If the pH is not
neutral an irrigating contact lens should be used to apply
continuous irrigation for several hours until the pH of the
tissue normalizes. Test visual acuity and examine the eyes
for corneal damage and treat appropriately. Immediately consult
an ophthalmologist for patients who have corneal injuries.
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Ingestion Exposure |
In cases of ingestion, do not induce
emesis or offer activated charcoal.
Give 4 to 8 ounces of water or milk to
alert patients who can swallow if not done previously. Dilutants
are contraindicated in the presence of shock, upper airway
obstruction, or in the presence of perforation.
Direct visualization of the esophagus
is of primary importance for determining the extent of injury.
All patients who are suspected of having significant ingestion,
or those (such as children) for whom there is an unreliable
history, must have early endoscopy within 36 to 48 hours of
ingestion. Use of a flexible endoscope is associated with
a lower risk of perforation. The esophagus, stomach and duodenum
should be endoscopically evaluated because burns of the esophagus
do not correlate with the presence of burns in the stomach.
Contraindications for endoscopy include:
unstable patient, evidence of perforation, upper airway compromise,
or more than 48 hours after ingestion.
Gastric lavage is not generally recommended
for hypochlorite ingestion.
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Antidotes and Other
Treatments |
There is no specific antidote for hypochlorite.
Treatment is supportive.
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Laboratory Tests |
The diagnosis of acute hypochlorite toxicity
is primarily clinical. However, laboratory testing is useful
for monitoring the patient and evaluating complications. Routine
laboratory studies for all exposed patients include CBC, glucose,
and electrolyte determinations. Patients who have respiratory
complaints may require pulse oximetry (or ABG measurements)
and chest radiography. Chlorine inhalation may be complicated
by hyperchloremic metabolic acidosis; in addition to electrolytes,
monitor blood pH.
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Disposition and
Follow-up |
Consider hospitalizing patients who have
a suspected significant exposure or have eye burns or serious
skin burns. Patients with perforation should be prepared for
emergency surgery.
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Delayed Effects |
Patients who ingested large volumes of
hypochlorite, who have unreliable histories, or are symptomatic
complaining of pain in swallowing, persistent shortness of
breath, severe cough, or chest tightness should be admitted
to the hospital and observed until symptom-free. Injury may
progress for several hours.
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Patient Release |
Asymptomatic patients and those who experienced
only minor irritation of the nose, throat, eyes, or respiratory
tract may be released. In most cases, these patients will
be free of symptoms in an hour or less. They should be advised
to seek medical care promptly if symptoms develop or recur
(see the Hypochlorite--Patient Information Sheet below).
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Follow-up |
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Follow up is recommended for all hospitalized
patients because long-term gastrointestinal or respiratory
problems can result. Respiratory monitoring is recommended
until the patient is symptom-free. Chlorine-induced reactive
airways dysfunction syndrome (RADS) has been reported to persist
from 2 to 12 years.
Patients who have skin or corneal injury
should be re-examined within 24 hours.
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Reporting |
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendix III for a list of agencies that may be
of assistance.
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Calcium
Hypochlorite Patient Information Sheet |
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This handout provides information and
follow-up instructions for persons who have been exposed to
calcium or sodium hypochlorite.
Print this handout only. 20k
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What is hypochlorite? |
Calcium hypochlorite is generally available
as a white powder, pellets, or flat plates, while sodium hypochlorite
is usually a greenish yellow, aqueous solution. Hypochlorite
is used widely in cleaning agents, and in bleaching, drinking-water
and swimming-pool disinfecting. Calcium hypochlorite decomposes
in water to release chlorine and sodium hypochlorite solutions
and can release chlorine gas if mixed with other cleaning
agents.
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What immediate
health effects can be caused by exposure to hypochlorite? |
Hypochlorite powder, solutions, and vapor
are irritating and corrosive. Swallowing hypochlorite or contact
with the skin or eyes produces injury to any exposed tissues.
Exposure to gases released from hypochlorite may cause burning
of the eyes, nose, and throat; cough; and damage to the airway
and lungs. Generally, the more serious the exposure, the more
severe the symptoms.
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Can hypochlorite
poisoning be treated? |
There is no antidote for hypochlorite,
but its effects can be treated and most exposed persons get
well. Persons who have experienced serious symptoms may need
to be hospitalized.
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Are any future
health effects likely to occur? |
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a serious exposure, symptoms may
worsen for several hours.
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What tests can
be done if a person has been exposed to hypochlorite? |
Specific tests for the presence of hypochlorite
in blood or urine generally are not useful to the doctor.
If a severe exposure has occurred, blood and urine analyses
and other tests may show whether the lungs, heart, or brain
have been injured. Testing is not needed in every case.
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Where can more
information about hypochlorite be found? |
More information about hypochlorite can
be obtained from your regional poison control center, your
state, county, or local health department; the Agency for
Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
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Follow-up
Instructions
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Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only. 20k
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[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
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- difficulty swallowing, or pain in the abdomen or chest
- coughing or wheezing, difficulty breathing, shortness
of breath, or chest pain
- increased ocular pain or discharge, change in vision
- increased redness or pain or a pus-like discharge in the
area of a skin burn
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[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
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[ ] Call for an appointment with Dr.____
in the practice of ________.
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When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
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[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
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[ ] Do not perform vigorous physical
activities for 1 to 2 days.
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[ ] You may resume everyday activities
including driving and operating machinery.
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[ ] Do not return to work for _____days.
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[ ] You may return to work on a limited
basis. See instructions below.
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[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
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[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
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[ ] Avoid taking the following medications:
________________
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[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
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[ ] Other instructions: ____________________________________
_____________________________________________________
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- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or
by checking out the following Internet Web sites: ___________;__________.
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Signature of patient _______________
Date ____________
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Signature of physician _____________
Date ____________
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Where can
I get more information? |
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ATSDR can tell you where to find occupational
and environmental health clinics. Their specialists can recognize,
evaluate, and treat illnesses resulting from exposure to hazardous
substances. You can also contact your community or state health
or environmental quality department if you have any more questions
or concerns.
For more information, contact:
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Agency for Toxic Substances and Disease Registry
Division of Toxicology
1600 Clifton Road NE, Mailstop F-32
Atlanta, GA 30333
Phone: 1-888-42-ATSDR (1-888-422-8737)
FAX: (770)-488-4178
Email: ATSDRIC@cdc.gov
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