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HAND DISH DETERGENTS

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) These products are intended for the hand washing of dishes. They primarily contain anionic or nonionic surfactants and may also contain combinations of glycols, detergents, alcohols, and salts. Significant toxic effects from these chemicals are not expected. Hand dishwashing liquids are not to be confused with liquid automatic dishwashing detergents which are much more irritating, and may be caustic.

Specific Substances

    A) CONSTITUENTS OF THE GROUP
    1) Dish detergent, hand
    2) Detergent (hand dish)
    3) Dishwashing liquids
    4) Non-automatic dishwashing detergents

Available Forms Sources

    A) FORMS
    1) Some hand dish detergent product names include: Sunlight(R), Dove(R), Ivory(R), Joy(R), Palmolive(R) and Dawn(R).
    B) USES
    1) These products are intended for the hand washing of dishes. They primarily contain anionic or nonionic surfactants and may also contain combinations of glycols, detergents, alcohols, and salts. Significant toxic effects from these chemicals are not expected. Hand dishwashing liquids are not to be confused with liquid automatic dishwashing detergents which are much more irritating, and may be caustic. Refer to "AUTOMATIC DISHWASHER DETERGENTS" for more information.

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: These products are intended for the hand washing of dishes. They primarily contain anionic or nonionic surfactants and may also contain combinations of glycols, detergents, alcohols, and salts. Significant toxic effects from these chemicals are not expected. Hand dishwashing liquids are not to be confused with liquid automatic dishwashing detergents which are much more irritating, and may be caustic.
    B) TOXICOLOGY: Detergents dissolve lipid layers in tissue and produce local irritation and injury.
    C) EPIDEMIOLOGY: Exposures are very common, but significant effects are rare.
    D) WITH POISONING/EXPOSURE
    1) The most common effect is gastrointestinal irritation. Nausea, vomiting and diarrhea may occur, but are usually self-limited. Ocular exposure may be associated with minor irritation. The pH of these substances is generally between 5 and 7.3. Prolonged exposure may cause erythema, scaling, and fissuring of intact skin. This varies by brand of hand dishwashing liquids.

Laboratory Monitoring

    A) No specific lab work is needed in most patients.
    B) If patients have more than mild symptoms, testing should be directed at evaluation of other causes for the symptoms.
    C) Monitor serum electrolytes in patients with significant vomiting and/or diarrhea.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF MILD TOXICITY
    1) Treatment is primarily symptomatic and supportive.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Treatment is primarily symptomatic and supportive. Severe toxicity is not expected after an ingestion. If patients have more than mild symptoms, testing should be directed at evaluation of other causes for the symptoms. Patients with persistent vomiting may require IV fluids.
    C) DECONTAMINATION
    1) PREHOSPITAL: Prehospital gastrointestinal decontamination is generally not required. If the patient has oral irritation they should rinse their mouth. Dilution with water or milk may decrease local irritation. Irrigate exposed eyes with large quantities of water.
    2) HOSPITAL: Severe toxicity is not expected after an ingestion. Gastrointestinal decontamination is generally not necessary. Consider activated charcoal only if coingestants with significant toxicity are involved. Irrigate exposed eyes and check pH after irrigation.
    D) AIRWAY MANAGEMENT
    1) Airway management is very unlikely to be necessary unless other toxic agents have been administered concurrently.
    E) ANTIDOTE
    1) None.
    F) PITFALLS
    1) Missing an ingestion of another chemical or other possible etiologies for a patient’s symptoms.
    G) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients with mild mucosal, eye or skin irritation or self-limited GI symptoms after an inadvertent exposure may be observed at home.
    2) OBSERVATION CRITERIA: Patients with persistent GI, skin or eye irritation or self-harm ingestions should be referred to a healthcare facility for evaluation and treatment.
    3) ADMISSION CRITERIA: Patients with persistent respiratory or GI symptoms or evidence of caustic injury be admitted. However, testing should be directed at evaluation of other causes for the symptoms.
    4) CONSULT CRITERIA: A toxicologist should be consulted if there is a question of possible systemic toxicity. Consult an ophthalmologist for a patient with evidence of corneal injury.
    H) DIFFERENTIAL DIAGNOSIS
    1) Differential diagnosis includes other causes of mucosal irritation such as caustics, hydrocarbons or other irritants.
    0.4.4) EYE EXPOSURE
    A) Eye exposure should be treated with irrigation until the conjunctival pH is normalized. Patients with persistent symptoms or evidence of corneal injury should have an ophthalmology evaluation (slit-lamp exam).

Range Of Toxicity

    A) TOXICITY: Inadvertent exposures usually result in mild, transient irritation. Symptom onset and duration is highly dependent on the type and amount of product and individual patient variation.

Clinical Effects

Summary Of Exposure

    A) USES: These products are intended for the hand washing of dishes. They primarily contain anionic or nonionic surfactants and may also contain combinations of glycols, detergents, alcohols, and salts. Significant toxic effects from these chemicals are not expected. Hand dishwashing liquids are not to be confused with liquid automatic dishwashing detergents which are much more irritating, and may be caustic.
    B) TOXICOLOGY: Detergents dissolve lipid layers in tissue and produce local irritation and injury.
    C) EPIDEMIOLOGY: Exposures are very common, but significant effects are rare.
    D) WITH POISONING/EXPOSURE
    1) The most common effect is gastrointestinal irritation. Nausea, vomiting and diarrhea may occur, but are usually self-limited. Ocular exposure may be associated with minor irritation. The pH of these substances is generally between 5 and 7.3. Prolonged exposure may cause erythema, scaling, and fissuring of intact skin. This varies by brand of hand dishwashing liquids.

Heent

    3.4.3) EYES
    A) Ocular exposure may be associated with minor irritation. The pH of these substances is generally between 5 and 7.3 (Grammer-West et al, 1996).
    B) SPLASH CONTACT: Ocular exposure should not result in serious toxicity or permanent impairment of vision. Surfactants are cytotoxic when incubated with rabbit corneal cells using SIRC testing methods; however, there are no reports which confirm ocular toxicity in humans (North-Root et al, 1985). Anionic and amphoteric surfactants are more cytotoxic than nonionic surfactants (North-Root et al, 1985).
    C) IRRITATION: Severe pain with a subsequent corneal epithelial defect and wrinkling of Descemet's membrane occurred in a patient who used a hand dishwashing liquid on a contact lens and then applied the contact lens to his eye. The patient was unable to remove the contact lens for approximately 10 minutes due to the severity of pain. The cornea gradually healed following treatment with corticosteroids and antibiotics (Grant & Schuman, 1993).
    3.4.6) THROAT
    A) IRRITATION: Exposure to the mouth and throat may cause irritation. There is a great variability in the irritant nature of these products, but none should be caustic (Grammer-West et al, 1996).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) NAUSEA AND VOMITING
    1) Almost all of these agents are GI irritants, but NOT caustic. Nausea and vomiting are the most frequent symptoms (Haddad et al, 1998).
    B) DIARRHEA
    1) Diarrhea is a common finding after significant ingestion (Haddad et al, 1998).
    3.8.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) ESOPHAGITIS
    a) RATS: One rat study evaluated the issue of chronic detergent ingestion using the premise that we ingest large amounts of detergent products. The study results indicated that the rats developed corrosive esophagitis and varying degrees of intestinal atrophy and mucosal sloughing. The study was suspect in that only 6 rats were used, and that the doses ingested by the rats on a mg/kg basis were 10 to 100 times higher than would reasonably be expected in humans (Mercurius-Taylor et al, 1984).
    1) A follow-up study failed to show any overt or pathological evidence of toxicity secondary to chronic detergent ingestion. It should not pose a problem to children or adults (Scailteur et al, 1986).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) These materials may be irritating to broken skin.
    2) In humans, prolonged exposure during 5-day dermatologic patch testing (24 hours/day on day 1, 6 hours/day on days 2 through 5) produced erythema, scaling, and fissuring of intact skin. This varied greatly by brand of hand dishwashing liquids (Grammer-West et al, 1996).
    B) SKIN IRRITATION
    1) Chronic exposure to dishwashing liquids can produce dermal irritation (Brown, 1971).
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) DERMATITIS
    a) RABBITS: Petersen (1988) conducted a study using rabbits to evaluate the percutaneous toxicity of two hand dishwashing detergents containing anionic surfactants. The concentrations of the detergents were 2 to 12.5 times higher than those normally used and the duration of exposure was 15 times longer than the normal human exposure. After 91 days of study there were no treatment-related deaths nor evidence of adverse systemic effects. However, slight to moderate dermal irritation consisting of erythema, edema, and desquamation confined to the application site was reported in one of the two detergents tested (Petersen, 1988).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No specific lab work is needed in most patients.
    B) If patients have more than mild symptoms, testing should be directed at evaluation of other causes for the symptoms.
    C) Monitor serum electrolytes in patients with significant vomiting and/or diarrhea.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients with persistent respiratory or GI symptoms or evidence of caustic injury should be admitted. However, testing should be directed at evaluation of other causes for the symptoms.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients with mild mucosal, eye or skin irritation or self-limited GI symptoms after an inadvertent exposure may be observed at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) A toxicologist should be consulted if there is a question of possible systemic toxicity. Consult an ophthalmologist for a patient with evidence of corneal injury.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with persistent GI, skin or eye irritation or self-harm ingestions should be referred to a healthcare facility for evaluation and treatment.

Monitoring

    A) No specific lab work is needed in most patients.
    B) If patients have more than mild symptoms, testing should be directed at evaluation of other causes for the symptoms.
    C) Monitor serum electrolytes in patients with significant vomiting and/or diarrhea.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Prehospital gastrointestinal decontamination is generally not required. If the patient has oral irritation they should rinse their mouth. Dilution with water or milk may decrease local irritation. Irrigate exposed eyes with large quantities of water.
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY: Severe toxicity is not expected after an ingestion. Gastrointestinal decontamination is generally not necessary. Consider activated charcoal only if coingestants with significant toxicity are involved.
    B) ACTIVATED CHARCOAL
    1) Consider activated charcoal only if coingestants with significant toxicity are involved.
    2) CHARCOAL ADMINISTRATION
    a) Consider administration of activated charcoal after a potentially toxic ingestion (Chyka et al, 2005). Administer charcoal as an aqueous slurry; most effective when administered within one hour of ingestion.
    3) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.3) TREATMENT
    A) MONITORING OF PATIENT
    1) No specific lab work is needed in most patients.
    2) If patients have more than mild symptoms, testing should be directed at evaluation of other causes for the symptoms.
    3) Monitor serum electrolytes in patients with significant vomiting and/or diarrhea.

Eye Exposure

    6.8.1) DECONTAMINATION
    A) Eye exposure should be treated with irrigation until the conjunctival pH is normalized. Patients with persistent symptoms or evidence of corneal injury should have an ophthalmology evaluation (slit-lamp exam).

Range Of Toxicity

Summary

    A) TOXICITY: Inadvertent exposures usually result in mild, transient irritation. Symptom onset and duration is highly dependent on the type and amount of product and individual patient variation.

Maximum Tolerated Exposure

    A) GENERAL/SUMMARY
    1) Inadvertent exposures usually result in mild, transient irritation. Symptom onset and duration is highly dependent on the type and amount of product and individual patient variation.
    2) In 1990, the American Association of Poison Control Centers National Data Collection System recorded 11,352 exposures to hand dish detergents. Of these, only 63 had a moderate outcome and 1 had a major outcome. No deaths were reported (Litovitz et al, 1991).

Pharmacology Toxicology

Toxicologic Mechanism

    A) The products are non-caustic irritants of the gastrointestinal tract and other mucous membranes.

References

General Bibliography

    1) Brown VK: A comparison of predictive irritation tests with surfactants on human and animal skin. J Soc Cosmet Chem 1971; 22:411.
    2) Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
    3) Elliot CG, Colby TV, & Kelly TM: Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96:672-674.
    4) FDA: Poison treatment drug product for over-the-counter human use; tentative final monograph. FDA: Fed Register 1985; 50:2244-2262.
    5) Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
    6) Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
    7) Grammer-West NY, Fitzpatrick JE, & Jackson RL: Comparison of the irritancy of hand dishwashing liquids with modified patch testing methods. J Am Acad Dermatol 1996; 35:258-260.
    8) Grant WM & Schuman JS: Toxicology of the Eye, 4th ed, Charles C Thomas, Springfield, IL, 1993.
    9) Haddad LM, Shannon MW, & Winchester JF: Clinical Management of Poisoning and Drug Overdose, 3rd ed. W.B, Saunders Company, Philadelphia, PA, 1998.
    10) Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
    11) Litovitz TL, Bailey KM, & Schmitz BF: 1990 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1991; 9:461-509.
    12) Mercurius-Taylor LA, Jayaraj AP, & Clark CG: Is chronic detergent ingestion harmful to the gut?. Br J Ind Hyg 1984; 40:279-281.
    13) None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
    14) North-Root H, Yackovich F, & Demetrulias J: Prediction of eye irritation potential of shampoos using the in vitro SIRC cell toxicity test. Fd Chem Toxic 1985; 23:271-273.
    15) Petersen DW: Lemon aesthetics in hand dishwashing detergents do not influence reported accidental ingestion frequency and volume. Vet Hum Toxicol 1989; 31:257-258.
    16) Petersen DW: Subchronic percutaneous toxicity testing of two liquid hand dishwashing detergents. Food Chem Toxicol 1988; 26:803-806.
    17) Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
    18) Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
    19) Scailteur V, Maurer JK, & Walker AP: Subchronic oral toxicity testing in rats with a liquid hand-dishwashing detergent containing anionic surfactants. Fd Chem Toxic 1986; 24:175-181.