Annex II: Case reports involving children and CPRF or CAP

From January 1 2006 to April 20 2006, the Texas Poison Centre reported 104 human exposures relating to the ingestion of “Fabuloso”, a cleaning product that tastes and smells good (Miller et al. 2006). Among these 104 cases, 92 were considered accidental ingestions; 60 cases involved children <6 years old. Fabuloso is a household cleaning product that is a minor gastrointestinal irritant and unlikely to cause any major morbidity or mortality. It could be considered as a product that might easily mislead consumers into unintentionally ingesting this product.

Case reports involving the elderly and CPRF

Severe health impairment with a lethal outcome in an 82-year-old female temporally related to the ingestion of ca. 100 ml of a liquid detergent

The Rostock University Hospital reported a case of severe health impairment with a lethal outcome in a female patient aged 82 years who, at her home, had ingested ca. 100 ml of a liquid detergent containing ca. 25% surfactants. Although the course of her illness had been fairly uncomplicated, the patient died after 11 days from aspiration pneumonia associated with septicaemia. This woman suffered initial senile dementia and was in need of care.

( www.bfr.bund.de/cm/255/cases_of_poisoning_reported_by_physicians_2006.pdf)

Accidental intake of a cleaning agent mistaken for orange juice by an elderly patient

A 69-year-old patient accidentally ingested a sip of a cleaning agent, having mistaken the product for orange juice because of its colour and the package design which resembled that of a food product. The label showed a picture of oranges and the word “Orange” appeared in the product name.

In addition to surfactants, the cleaner involved contains a relatively high share of synthetic essential oils.

The patient saw a doctor because of a burning sensation in his mouth and throat. No cough was observed. The attending physician consulted a poison control centre to assess the risk and initiate appropriate treatment. Because the cleaner contained a surfactant, the patient was administered an agent to prevent foam formation. In addition, he was recommended to drink fluid. Findings from the physical examination were non-significant, and admission to hospital was not required.

An enquiry at the Berlin poison emergency telephone service revealed that the product concerned had been involved in only one case of poisoning so far. ( www.bfr.bund.de/cm/255/cases_of_poisoning_reported_by_physicians_2007.pdf)

Death after ingestion of surfactants: A particular risk for patients suffering from dementia

In a state of mental confusion, a 79-year-old male ingested ca. 200 ml of a detergent containing surfactants at his home. Despite cardiopulmonary resuscitation (CPR), the patient died at the hospital within 60 minutes, from lung oedema. (http://www.bfr.bund.de/cm/255/cases_of_poisoning_reported_by_physicians_2005.pdf)

Death of an elderly female due to aspiration of a dishwashing detergent and gastric contents

An 80-year-old patient accidentally ingested an unknown quantity of a manual dishwashing detergent containing surfactants. Because of its orange colour and the picture of oranges shown on the package label, the patient had in all likelihood mistaken the detergent for a food product, most probably orange juice. The following morning, she was found dead in her bed by her husband. There were no indications of a suicide risk in her history. The patient had been suffering from senile dementia. According to the forensic physicians, an aspiration of gastric contents containing the dishwashing detergent ingested had been the cause of death. The formation of foam from the surfactant ingested had presumably caused vomiting which led to the aspiration of gastric contents containing the dishwashing detergent. ( www.bfr.bund.de/cm/255/cases_of_poisoning_reported_by_physicians_2008.pdf)

Cases of CPRF poisoning in children

The risk of mistaking consumer goods for foods as a result of their misleading appearance has recently been identified by the BfR in two cases of poisoning by another product. The product in question was an orange liquid with packaging resembling a beverage bottle, and the word “orange” in the product name. The product was accidentally ingested by an elderly person and a child. ( www.bfr.bund.de/cm/255/cases_of_poisoning_reported_by_physicians_2008.pdf)

Source: SCCS,  Opinion on the potential health risks posed by chemical consumer products resembling food and/or having child-appealing properties, (2011),
Annex II, p.37