Chlorhexidine Poisoning

Availability of Products in HKGU

• Chlorhexidine Gluconate 0.2% mouthwash
• Chlorhexidine Gluconate 0.05% (commonly used as antiseptic wipe)
• Chlorhexidine Gluconate 4% scrub (commonly used for scrubbing)
• Chlorhexidine Gluconate 5% solution (pure/ for dilution to other products)
• Chlorhexidine Gluconate 0.5% in 70% Alcohol (umbilical cord wipes)

Ingestion (general):

• Mildly irritant
• Not systemically toxic after ingestion of up to 150mg/kg due to poor absorption
• There is case report of hepatitis and oral-oesophageal ulceration following ingestion of 400mg/kg
• Gastritis reported following chronic ingestion of Chlorhexidine
• Treat with gastric lavage using milk, raw egg, gelatin or mild soap.
• Employ supportive measures as appropriate

Children

• Ingestion of 30-60ml of Chlorhexidine gluconate oral rinse by a small child (~10 kg body weight) might result in gastric distress, including nausea, or signs of alcohol intoxication.
• Medical attention should be sought if more than 120ml of Chlorhexidine gluconate oral rinse is ingested by a small child or if signs of alcohol intoxication develop

Severe Toxicity

• Case report of ingestion of Chlorhexidine Gluconate 5% solution. Fatal due to acute respiratory distress syndrome (ARDS) 12 h after ingestion, from systemic absorption of aspirated gastric content via the alveoli

Based on Chlorhexidine Gluconate 0.5% in 70%

SWALLOWED

·         If swallowed do NOT induce vomiting.

·         If vomiting occurs, lean patient forward or place on left side (head-down position, if possible) to maintain open airway and prevent aspiration.

·         Observe the patient carefully.

·         Never give liquid to a person showing signs of being sleepy or with reduced awareness; i.e. becoming unconscious.

EYE

·         Wash out immediately with fresh running water.

·         Ensure complete irrigation of the eye by keeping eyelids apart and away from eye and moving the eyelids by occasionally lifting the upper and lower lids.

·         Seek medical attention without delay; if pain persists or recurs seek medical attention.

·         Removal of contact lenses after an eye injury should only be undertaken by skilled personnel.

SKIN

·         Immediately remove all contaminated clothing, including footwear.

·         Flush skin and hair with running water (and soap if available).

·         Seek medical attention in event of irritation.

INHALED

·         If fumes or combustion products are inhaled remove from contaminated area.

·         Lay patient down. Keep warm and rested.

·         Prostheses such as false teeth, which may block airway, should be removed, where possible, prior to initiating first aid procedures.

·         Apply artificial respiration if not breathing, preferably with a demand valve resuscitator, bag-valve mask device, or pocket mask as trained. Perform CPR if necessary.

NOTES TO PHYSICIAN

·         Treat symptomatically.

·         Establish airway and assist ventilation with positive end expiratory pressure, if required, after endotracheal intubation.

·         Circulatory competence must be maintained - monitor blood pressure carefully.

·         Induction of emesis with Ipecac may be contraindicated as a result of biguanide-induced gastric mucosal irritation.

·         Gastric lavage, following endotracheal intubation may be preferred. Activated charcoal and cathartics placed through the lavage tube may be useful

References:

1. http://www.ncbi.nlm.nih.gov/pubmed/11931511
2. http://www.drugs.com/pro/chlorhexidine.html
3. Oxford Desk Reference: Toxicology
4. Chemwatch Material Safety Data Sheet (REVIEW). Issue Date: 27-Jun-2012