Sodium bisulfate poisoning

Sodium bisulfate

Sodium bisulfate is found in:

• Household cleaners
• Certain liquid detergents
• Metal finishing
• Swimming pool pH additives

Note: This list may not be all inclusive.

Symptoms from swallowing more than a tablespoon (15 milliliters) of this acid may include:

• Breathing difficulty
• Burning pain in the mouth
• Chest pain from burns of the esophagus (swallowing tube)
• Diarrhea
• Drooling
• Gaggling sensation
• Vomiting, sometimes bloody
• Severe low blood pressure (shock) causing weakness

If the chemical touches your skin, symptoms may include:

• Blisters
• Burns
• Painful, red skin

If it gets in your eyes, you may have:

• Decreased vision
• Eye pain
• Eye redness and tearing

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 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 chemical is on the skin or in the eyes, flush with lots of water (at least 2 quarts or 1.9 liters) for at least 15 minutes.

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

The following information is helpful for emergency assistance:

• Person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• 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 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 ventilator (breathing machine)
• Blood and urine tests
• Camera down the throat to see burns in the airway (bronchoscopy)
• Camera down the throat to see burns in the esophagus (food pipe) and the stomach (endoscopy)
• Chest x-ray
• CT (computerized axial tomography) scan
• ECG (electrocardiogram, or heart tracing)
• Fluids through the vein (intravenous or IV)
• Medicines to treat symptoms
• Tube through the mouth to remove the poison only if a large amount was swallowed within 30 to 45 minutes of arrival in the emergency room.

Note: Activated charcoal does not effectively treat (adsorb) sodium bisulfate poisoning.

For skin exposure, treatment may include:

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

Hospital admission may be necessary to continue treatment. Surgery may be required if the esophagus, stomach or intestine have developed holes (perforation) from exposure to the acid.

How well a person does depends on how rapidly the sodium bisulfate was diluted and neutralized. There is a good chance of recovery if proper treatment is given soon after the poison was swallowed. Without prompt treatment, extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible, depending on how exposure occurred. Holes (perforations) in the esophagus and stomach may result in serious infections in both the chest and abdominal cavities, which may result in death.

Damage to the esophagus may occur as late as 2 to 3 weeks after swallowing the poison. Death may occur up to 1 month or longer after swallowing the poison. Those who recover may have continued stomach or esophagus problems, including cancer.

Hoyte C. Caustics. In: Walls RM, eds. 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.