Benzalkonium Chloride Poisoning in Infant Twins

Abstract

\s=b\ Infant twins sustained severe circumoral and pharyngeal burns from a concentrated solution of benzalkonium (Zephiran) chloride prescribed for treatment of candidiasis. This report emphasizes the unnecessary hazard accompanying use of a potentially toxic drug\p=m-\especially when prepared in error by the pharma-cist\p=m-\whena safer drug (nystatin) is available for treatment of oral candidiasis.Risks from use of a prescription drug for other than the intended patient are also highlighted by this episode of poisoning.

Comparative study on toxic effects induced by oral or intravascular administration of commonly used disinfectants and surfactants in rats

“…Disinfectants and surfactants are used widely as an active ingredient in household and personal care products like dishwashing and laundry liquids, bleach and cosmetics that are commercially available in supermarkets. These products are daily necessities and accidental ingestion by old people or young children seems to have occurred more frequently than previously reported (Berkel and Wolff, ; Ohta et al , ; Wilson and Burr, ; Hironaga, ; Ichihara et al , ; Nagai et al , ; Mucklow, ; Balit et al , ; Ishigami et al , ; Kudo et al , ; Usui et al , ; Massano et al , ; Hirata and Kurokawa, ; Adelson and Sunshine, ; Hitosugi et al , ; Akutsu et al , ). The annual report of poisoning, required from 1998 to 2009 by The Japan Poison Information Center (), showed that household products were the highest poison hazards and their percentage of total causative materials was over than 64% every year.…”

Benzalkonium Chloride Poisoning in Pediatric Patients: Report of Case with a Severe Clinical Course and Literature Review

“…In a review of cases of both adults [ 16 , 43 , 44 ] and children [ 45 , 46 , 47 , 48 , 49 ] who survived the ingestion of BAC solutions, strictures were described in only a few neonatal cases [ 48 ]. Therefore, the positive outcome in our patient and the management or nature of the substance involved are likely not directly nor causally related.…”

“…Conversely, only three adult cases involving oral exposure to BAC have been documented ( Table 2 ). In all instances, the concentration of the BAC solution was found to be at least 10% [ 16 , 44 , 45 , 47 , 49 ], except for a single adult case where a solution with a concentration of less than 10% was ingested [ 43 ]. Currently, this case report is the only available report that suggests that even low concentrations of BAC can lead to severe symptoms.…”

“…Chemical lung injury was observed in more than half of the patients. Concurrently, esophageal corrosive lesions were reported in almost all patients, but the majority did not experience long-term consequences [ 16 , 44 , 45 , 47 , 49 ]. All pediatric cases had a favorable outcome, whereas both of the adults who had intentionally ingested the substance were reported as deceased, which highlights the greater severity of intentional poisoning compared with unintentional poisoning [ 16 , 44 , 45 , 47 , 49 ].…”

Corrosive Esophagitis with Benzalkonium Chloride in a Two Days Old Neonate

“…BAC was formerly used in low concentrations for oral candidiasis; however it is replaced by nistatine treatment [ 8 ]. Depending on the amount of BAC contacted, burns ranging from mild to severe may occur on lips, tongue, pharynx, hipopharynx, larynx, esophagus and stomach.…”