Toxicology Brief: Sodium hypochlorite bleach ingestion in two dogs - Veterinary Medicine
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Toxicology Brief: Sodium hypochlorite bleach ingestion in two dogs


Table 3: Serum Chemistry Profile Results
The female dog had severely elevated sodium and chloride concentrations (Table 3). The anion gap was moderately elevated, with a marked decrease in the enzymatic carbon dioxide concentration. The blood urea nitrogen (BUN) concentration was mildly elevated, and the creatinine concentration was at the high end of the reference interval. The female dog's magnesium, phosphorus, glucose, and calcium concentrations were also elevated. A moderate hypocholesterolemia was also observed.

In the male dog, the serum sodium, chloride, BUN, creatinine, and magnesium concentrations were elevated, as were the alanine transaminase and alkaline phosphatase activities and the anion gap (Table 3). Decreased calcium, total protein, and enzymatic carbon dioxide concentrations were also present.

Treatment, radiographic examination, and outcome

The dogs were admitted to the intensive care unit, and flow-by oxygen was administered. Initial intravenous fluid therapy consisted of boluses of warmed lactated Ringer's solution. The animals were dried and placed under warm-air circulating blankets to treat the hypothermia. Initial gastroprotectant therapy was limited to intravenous famotidine because of continued vomiting episodes.

Thoracic and abdominal radiographic examination of the female dog revealed interstitial and peribronchial infiltrates in the right middle and cranial lung lobes, with distention of the stomach and small intestines by a mixture of fluid and air. These findings were consistent with severe gastroenteritis and pneumonia. Since pulmonary complications resulting from bleach aspiration are reported to contribute to death in people,3 aspiration of bleach or vomitus was given primary consideration as a cause of the pulmonary radiographic abnormalities.

Despite continued treatment with fluid therapy and anti-inflammatory doses of intravenous dexamethasone in both dogs and intravenous calcium supplementation in the male dog, the animals continued to clinically deteriorate. The female dog remained hypothermic and developed profuse, watery diarrhea; its neurologic status declined to a borderline comatose state, and its breathing became progressively labored. The male dog also developed increased respiratory effort, and it remained severely ataxic, though its temperature did improve to 97 F (36.1 C). A marked decrease in urine production was noted in the male, and a urinary catheter was placed. The development of oliguria despite aggressive fluid therapy was concerning for acute renal failure.

Both animals were euthanized less than 12 hours after admission. The owner declined a request to perform necropsies on the dogs.

DISCUSSION

To our knowledge, this is the first report of sodium hypochlorite bleach ingestion in animals. Although no specific reports were found, most veterinary toxicology books associate bleach ingestion with varying degrees of caustic injury to the gastrointestinal tract and possibly secondary respiratory or ocular lesions due to irritation from chemical fumes.2 Death from ingestion of bleach or other hypochlorite-containing products also has not been reported in animals. A case involving calcium hypochlorite ingestion in a dog was recently reported, but severe systemic involvement was not observed and the dog survived.4

Toxic dose

The clinical outcome of sodium hypochlorite bleach toxicosis in people is often determined by the concentration of sodium hypochlorite in the product and the volume ingested.1,2 Sodium hypochlorite concentrations vary considerably depending on the type of product. For example, some household products may contain < 3%, while industrial products may contain up to 15%. Other related compounds containing hypochlorite salts, such as swimming pool products, may contain up to 50% hypochlorite.2

Clorox Regular-Bleach contains 6.15% (weight/volume) sodium hypochlorite and < 1% sodium hydroxide. The sodium hypochlorite concentration in this product is approximately 61.5 mg/ml. Sodium hypochlorite contains 31% sodium and 48% chloride by weight, equivalent to approximately 19.1 mg/ml of sodium and 30 mg/ml of chloride.


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Source: VETERINARY MEDICINE,
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