Toxicity of anti-septics and disinfectants

Anti-septics are those which are use to kill the microorganisms on skin surface . Disinfectants are those used to kill microorganisms in inanimate objects. Both antiseptic and disinfectant are antimicrobial agents that may contain same chemicals but concentration is lower in antiseptics

Sources:

• Phenol derivatives: phenol ,Dettol
• Alcohols: Ethanol, isopropanol
• Oxidizing agents: hydrogen peroxide
• Biguanides: chlorhexidine
• Halogens: iodine, chlorine
• Quaternary ammonium: cetrimide
• Detergents

These are commonly found in sanitizer, scrub, spirit, betadin .

Mode of transmission.:

They are mainly transmitted through oral, inhalation and dermal route.

Mechanism of action:

Phenol:  Phenol and related compounds are directly cytopathic ,denatures protein , alters the permeability of cell membranes . causes coagulative necrosis . Phenolics can induce oxidative stress in a variety of cells.

Alcohol: Increases the function of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and cause CNS depression, disruption of cell membrane and denaturation of protein. Irritates skin and mucous membrane.

Hydrogen peroxide: Corrosive damage, formation of oxygen gas leads to gas embolism and CNS damage, cytotoxic effect via lipid peroxidation.

Chlorhexidine gluconate:  chlorhexidine salts dissociate and release the positively charged chlorhexidine cation, at high concentrations, membrane disruption results in cell death. Ototoxic effect

Povidone iodine : Corrosive injury to the gastrointestinal tract due to its oxidizing properties and denaturation of protein.

Clinical signs :

1. Alcohol: CNS depression, ataxia, lethargy, sedation, Hypothermia, metabolic acidosis, bloating, abdominal pain, flatulence, nausea, vomiting
2. Phenol

• GIT irritation and ulceration
• Hypersalivation, emesis, diarrhea, laryngeal edema
• Ataxia, tremors, CNS stimulation or depression, seizures, or coma.
• Hepatic and renal failure within 12-24 hours of exposure
• respiratory depression and panting (in dogs), dyspnea, aspiratory pneumonia

  3.hydrogen peroxide

• Corrosive to skin, eyes and mucus membrane in high concentration.
• Gas embolism, gastric irritation, gastric distension and emesis.
• Shortness of breath, accumulation of fluids in the lungs, congestion of trachea
• Seizure, cerebral infraction or cerebral embolism

4.Cationic detergent

• Muscle weakness
• Unconsciousness
• Breathing difficulties

5.Chlorohexidine toxicity in cats causes oral ulcers, pharyngitis, laryngitis and tracheitis.

Diagnosis

• History of exposure to antiseptics and disinfectant
• Clinical signs like irritation to the skin and mucous membrane, corrosive injury, vomiting
• Chemical analysis of vomitus, feces, urine and blood
• Examination of ulcerated skin and exposed mucus membrane
• Blood values: increased liver enzymes, BUN, creatinine, hemolytic anemia, methemoglobinemia, thrombocytopenia, Heinz body formation
• Dark green to black colored urine in case of phenol toxicity.
• Radiography of abdomen and chest to detect intravascular oxygen embolism in case of hydrogen peroxide toxicity.
• Postmortem: examination of liver, kidney and gastrointestinal tract.

 Treatment

• Remove source
• For dermal exposure, wash affected area with detergent and water. (water alone is not recommended because it may increase dermal absorption of phenol)
• For ocular exposure, flush with water or saline for 15 minutes.
• Emetics are not recommended because alcohol is rapidly absorbed from GIT & rapid onset of CNS depression and phenols are corrosive, risk of aspiration.
• Alcohols and hydrogen peroxides are poorly adsorbed by activated charcoal, so not recommended.
• Activated charcoal and cathartic for small animal in case of phenol poisoning. 10ml/kg olive oil
• Antidotes are not available for ethanol, isopropanol, phenol and hydrogen peroxide poisoning.
• Symptomatic treatment; dextrose therapy for hypoglycemia, sodium bicarbonate for metabolic acidosis
• N-acetylcysteine to prevent liver and kidney damage in phenolic poisoning. loading dose of 140mg/kg PO or V and then 70mg/kg q 4-6 hours.