Sodium hypochlorite poisoning

Sodium hypochlorite

Sodium hypochlorite is found in:

• Chemical used to add chlorine to swimming pools
• Disinfectants
• Some bleaching solutions
• Water purifiers

Note: This list may not be all inclusive.

Watered-down (diluted) sodium hypochlorite generally causes only mild stomach irritation. Swallowing larger amounts can cause more serious symptoms. Industrial-strength bleach contains much higher concentrations of sodium hypochlorite, which may cause severe injury.

NEVER mix ammonia with sodium hypochlorite (bleach or bleach-containing products). This common household error produces chlorine, which is a toxic gas that can cause choking and serious breathing problems.

Symptoms of sodium hypochlorite poisoning may include:

• Burning, tearing red eyes
• Burns of the esophagus
• Chest pain or tightness
• Coma (lack of responsiveness)
• Coughing (from the fumes)
• Delirium (agitation and confusion)
• Drooling
• Gagging sensation
• Low blood pressure
• Pain in the mouth or throat
• Skin irritation of the exposed area, burns, or blistering
• Shock (extremely low blood pressure)
• Slow heartbeat
• Stomach or abdominal pain
• Throat swelling, which leads to difficulty breathing
• Vomiting, sometimes bloody
• Weakness

Seek immediate medical help. DO NOT make a person throw up unless told to do so by poison control or a health care professional.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. DO NOT give water or milk if the person is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

If the person breathed in the poison, immediately move them to fresh air.

Determine the following information:

• The person's age, weight, and condition
• The name of the product (ingredients and strength, if known)
• The time it was swallowed
• The amount swallowed

However, DO NOT delay calling for help if this information is not immediately available.

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

The person will be admitted to a hospital. The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate.

The person may receive:

• Airway support, including oxygen, breathing tube through the mouth (intubation), and breathing machine (ventilator)
• Blood and urine tests
• Camera down the throat to see burns in the airway (bronchoscopy)
  
• Camera down the throat (endoscopy) to see burns in the esophagus and stomach
• Chest x-ray
• CT (computerized axial tomography) scan
• ECG (electrocardiogram, or heart tracing)
• Fluids through a vein (intravenous or IV)
• Medicines to treat symptoms

Note: Activated charcoal does not effectively treat sodium hypochlorite poisoning.

For skin exposure, treatment may include:

• Irrigation (washing of the skin), possibly every few hours for several days
• Surgical removal of burned skin (skin debridement)
• Transfer to a hospital that specializes in burn care

The person may need to be admitted to a hospital to continue treatment. Surgery may be needed if the esophagus, stomach, or intestines have holes (perforations) from the acid.

Swallowing, smelling, or touching small amounts of household bleach will likely not cause any significant problems. However, more severe problems can occur with industrial-strength bleach, or from mixing bleach with ammonia.

How well a person does depends on the amount of poison swallowed and how quickly treatment was received. The faster a person gets medical help, the better the chance for recovery.

Cancer of the esophagus is a high risk for people who live after ingesting sodium hypochlorite, especially industrial strength. 

Without prompt treatment, extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible, and may continue to occur for several weeks after the poison was swallowed. Holes (perforations) in the esophagus and stomach may cause serious infections in both the chest and abdominal cavities, which may result in death.

Bleach; Clorox; Carrel-Dakin solution

Aronson JK. Sodium hypochlorite and hypochlorous acid. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:418-420.

Hoyte C. Caustics. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 143.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.