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Sodium hypochlorite

1. NAME
   1.1 Substance
   1.2 Group
   1.3 Synonyms
   1.4 Identification numbers
      1.4.1 CAS number
      1.4.2 Other numbers
   1.5 Main brand names, main trade names
   1.6 Main manufacturers, main importers
2. SUMMARY
   2.1 Main risks and target organs
   2.2 Summary of clinical effects
   2.3 Diagnosis
   2.4 First aid measures and management principles
3. PHYSICO-CHEMICAL PROPERTIES
   3.1 Origin of the substance
   3.2 Chemical structure
   3.3 Physical properties
      3.3.1 Colour
      3.3.2 State/Form
      3.3.3 Description
   3.4 Hazardous characteristics
4. USES
   4.1 Uses
      4.1.1 Uses
      4.1.2 Description
   4.2 High risk circumstance of poisoning
   4.3 Occupationally exposed populations
5. ROUTES OF EXPOSURE
   5.1 Oral
   5.2 Inhalation
   5.3 Dermal
   5.4 Eye
   5.5 Parenteral
   5.6 Other
6. KINETICS
   6.1 Absorption by route of exposure
   6.2 Distribution by route of exposure
   6.3 Biological half-life by route of exposure
   6.4 Metabolism
   6.5 Elimination and excretion
7. TOXICOLOGY
   7.1 Mode of action
   7.2 Toxicity
      7.2.1 Human data
         7.2.1.1 Adults
         7.2.1.2 Children
      7.2.2 Relevant animal data
      7.2.3 Relevant in vitro data
      7.2.4 Workplace standards
      7.2.5 Acceptable daily intake (ADI)
   7.3 Carcinogenicity
   7.4 Teratogenicity
   7.5 Mutagenicity
   7.6 Interactions
8. TOXICOLOGICAL ANALYSES AND BIOMEDICAL INVESTIGATIONS
   8.1 Material sampling plan
      8.1.1 Sampling and specimen collection
         8.1.1.1 Toxicological analyses
         8.1.1.2 Biomedical analyses
         8.1.1.3 Arterial blood gas analysis
         8.1.1.4 Haematological analyses
         8.1.1.5 Other (unspecified) analyses
      8.1.2 Storage of laboratory samples and specimens
         8.1.2.1 Toxicological analyses
         8.1.2.2 Biomedical analyses
         8.1.2.3 Arterial blood gas analysis
         8.1.2.4 Haematological analyses
         8.1.2.5 Other (unspecified) analyses
      8.1.3 Transport of laboratory samples and specimens
         8.1.3.1 Toxicological analyses
         8.1.3.2 Biomedical analyses
         8.1.3.3 Arterial blood gas analysis
         8.1.3.4 Haematological analyses
         8.1.3.5 Other (unspecified) analyses
   8.2 Toxicological Analyses and Their Interpretation
      8.2.1 Tests on toxic ingredient(s) of material
         8.2.1.1 Simple Qualitative Test(s)
         8.2.1.2 Advanced Qualitative Confirmation Test(s)
         8.2.1.3 Simple Quantitative Method(s)
         8.2.1.4 Advanced Quantitative Method(s)
      8.2.2 Tests for biological specimens
         8.2.2.1 Simple Qualitative Test(s)
         8.2.2.2 Advanced Qualitative Confirmation Test(s)
         8.2.2.3 Simple Quantitative Method(s)
         8.2.2.4 Advanced Quantitative Method(s)
         8.2.2.5 Other Dedicated Method(s)
      8.2.3 Interpretation of toxicological analyses
   8.3 Biomedical investigations and their interpretation
      8.3.1 Biochemical analysis
         8.3.1.1 Blood, plasma or serum
         8.3.1.2 Urine
         8.3.1.3 Other fluids
      8.3.2 Arterial blood gas analyses
      8.3.3 Haematological analyses
      8.3.4 Interpretation of biomedical investigations
   8.4 Other biomedical (diagnostic) investigations and their interpretation
   8.5 Overall interpretation of all toxicological analyses and toxicological investigations
   8.6 References
9. CLINICAL EFFECTS
   9.1 Acute poisoning
      9.1.1 Ingestion
      9.1.2 Inhalation
      9.1.3 Skin exposure
      9.1.4 Eye contact
      9.1.5 Parenteral exposure
      9.1.6 Other
   9.2 Chronic poisoning
      9.2.1 Ingestion
      9.2.2 Inhalation
      9.2.3 Skin exposure
      9.2.4 Eye contact
      9.2.5 Parenteral exposure
      9.2.6 Other
   9.3 Course, prognosis, cause of death
   9.4 Systematic description of clinical effects
      9.4.1 Cardiovascular
      9.4.2 Respiratory
      9.4.3 Neurological
         9.4.3.1 Central nervous system (CNS)
         9.4.3.2 Peripheral nervous system
         9.4.3.3 Autonomic nervous system
         9.4.3.4 Skeletal and smooth muscle
      9.4.4 Gastrointestinal
      9.4.5 Hepatic
      9.4.6 Urinary
         9.4.6.1 Renal
         9.4.6.2 Other
      9.4.7 Endocrine and reproductive systems
      9.4.8 Dermatological
      9.4.9 Eye, ear, nose, throat: local effects
      9.4.10 Haematological
      9.4.11 Immunological
      9.4.12 Metabolic
         9.4.12.1 Acid-base disturbances
         9.4.12.2 Fluid and electrolyte disturbances
         9.4.12.3 Others
      9.4.13 Allergic reactions
      9.4.14 Other clinical effects
      9.4.15 Special risks
   9.5 Other
   9.6 Summary
10. MANAGEMENT
   10.1 General principles
   10.2 Life supportive procedures and symptomatic/specific treatment
   10.3 Decontamination
   10.4 Enhanced elimination
   10.5 Antidote treatment
      10.5.1 Adults
      10.5.2 Children
   10.6 Management discussion
11. ILLUSTRATIVE CASES
   11.1 Case reports from literature
12. Additional information
   12.1 Specific preventive measures
   12.2 Other
13. REFERENCES
14. AUTHOR(S), REVIEWER(S), DATE(S) (INCLUDING UPDATES), COMPLETE ADDRESS(ES)
    Sodium hypochlorite

    International Programme on Chemical Safety
    Poisons Information Monograph 495
    Chemical

    This Monograph contain the following
    sections completed: 1, 2, 3, 4.1, 4.2, 5, 7.1, 7.2, 9, 10, 12.1.

    1. NAME

        1.1  Substance

             Sodium hypochlorite

        1.2  Group

             Chlorine and compounds
             Hypochlorite

        1.3  Synonyms

             Bleach; Hypochlorite de sodium;
             Hypochlorous acid, sodium salt;
             Liquid bleach; Sodium oxychloride

        1.4  Identification numbers

             1.4.1  CAS number

                    7681-52-9

             1.4.2  Other numbers

                    UN/NA Number: 1791
                    RTECS Number: NH3486300
                    EU EINECS/ELINCS NUMBER: 231-668-3

        1.5  Main brand names, main trade names

        1.6  Main manufacturers, main importers

    2.  SUMMARY

        2.1  Main risks and target organs

             Sodium hypochlorite solution causes moderate mucosal
             irritation, the extent of which depends very much on the
             volume ingested, the viscosity and concentration of the
             preparation and the duration of contact. Although sodium
             hypochlorite solution is alkaline it does not tend to cause
             corrosive damage except in large quantities or concentrated
             solutions. Sodium hypochlorite may release small amounts of
             chlorine and hypochlorous acid when acidified, but usually in
             concentrations too small to cause any significant damage.
             This release of chlorine often causes problems when bleach is
             mixed with an acidic cleaning agent in the home.
    

             Most children who ingest sodium hypochlorite bleach swallow
             only small amounts and suffer nothing more than vomiting and
             gastrointestinal discomfort. Pulmonary complications, such as
             ARDS, usually resulting from aspiration, often contribute to
             death. The ingestion of industrial bleaches may pose more of
             a risk because of additional chemicals or higher alkalinity.

        2.2  Summary of clinical effects

             Gastrointestinal irritation, with nausea, vomiting and
             diarrhoea, is very common with ingestion of sodium
             hypochlorite solution. Haematemesis may occur with
             concentrated solutions. Household bleaches are unlikely to
             cause severe irritation unless contact is prolonged or the
             amount ingested is large. Severe oesophageal damage may occur
             from ingestion of bleach, but several reports have concluded
             that it is not common.
    
             Corrosive injury of the stomach  and hypernatraemia with
             hyperchloraemic acidosis  have all been reported usually
             following large intentional ingestions by adults.

        2.3  Diagnosis

             Clinical manifestation of mucous irritation of the eyes,
             respiratory and gastrointestinal (GI) tract together with the
             known hypochlorite exposure are essential. The main toxic
             effect is due to release of chlorine gas. pH indicator shows
             alkaline reaction in contact with the affected tissues.

        2.4  First aid measures and management principles

             Ingestion:
             Emesis is not recommended because of the risks associated
             with re-exposure of the oesophagus to sodium hypochlorite. In
             the majority of cases the only treatment necessary is plenty
             of fluids, especially milk. Less than 5 mL/kg oral ingestion
             of a 7% solution is unlikely to cause severe effects.
    
             Where a concentrated or highly alkaline solution has been
             ingested or the quantity swallowed is thought to be large,
             nasogastric aspiration of the stomach contents should be
             considered. Monitor the pH, sodium and chloride in severe
             cases. Give symptomatic and supportive care with intravenous
             (IV) fluids for hypotension. 
    
             The use of steroids and antibiotics in the management of
             corrosive injury is controversial and should be discussed
             with a poisons information service. Patients with suspected
             corrosive injury will require endoscopic examination to
             assess the extent of the damage.
    

             Inhalation (after exposure to chlorine gas):
             Patients without immediate symptoms may require no treatment,
             but a full physical examination and a record of respiratory
             peak flow may be of use in assessing any subsequent
             respiratory effects.
    
             Patients with mild effects: require a full physical
             examination and peak flow and discharge accordingly, and
             advised to return if symptoms recur or develop over the
             following 24 to 36 hours.
    
             Patients showing immediate moderate or severe effects: Check
             lung function and perform chest x-rays. Oxygen and
             bronchodilators (e.g. salbutamol; orally or inhaled) are used
             for bronchospasm. Pulmonary oedema should be treated with
             Positive End Expiratory Pressure (PEEP), or Constant Positive
             Airway Pressure (CPAP). Corticosteroids may inhibit the
             inflammatory response and should be considered in severe
             cases. Monitor arterial blood gases, treat hyperchloraemic
             acidosis.
    
             Patients with pre-existing respiratory disease: assess and
             consider admission for at least 24 hours.
    
             Please see PIM on Chlorine
    
             Dermal: Wash thoroughly with running water or saline. Treat
             as a thermal burn, if necessary.
    
             Please see PIM on Chlorine
    
             Eyes: Irrigate thoroughly for 10 to 15 minutes. Refer to an
             ophthalmologist.
    
             Please see PIM on Chlorine

    3.  PHYSICO-CHEMICAL PROPERTIES

        3.1  Origin of the substance

        3.2  Chemical structure

             Structural formula: Na.OCl
             Molecular Weight: 74.4

        3.3  Physical properties

             3.3.1  Colour

                    Green to yellow


             3.3.2  State/Form

                    Liquid

             3.3.3  Description

                    Melting Point: -6C (21 deg F) (5% solution)
                    Boiling Point: Decomposes above 40C (104 deg F)
                    Relative Density (Specific Gravity):About 1.1 (6%
                    solution);
                             1.21 (14% solution) (water = 1)
                    Solubility In Water: Soluble in all proportions
                    Solubility In Other Liquids: Reacts with many organic
                    solvents
                    pH value: Approx. 11
    
                    Odour chlorine (bleach) odour
                    Odour Threshold: Not applicable. Odour is due to
                    breakdown products such as chlorine.
    
                    Composition/Purity: Usually sold in solutions
                    containing 5 to 15% sodium hypochlorite in water, with
                    0.25 to 0.35% free alkali (usually NaOH) and 0.5 to
                    1.5% NaCl. Solutions of up to 40% sodium hypochlorite
                    in water are available. Solid sodium hypochlorite
                    (NaOCl.5H2O) is not commercially used.

        3.4  Hazardous characteristics

             Stability: Sodium hypochlorite solution decomposes
             slowly. Decomposition is speeded up by heat (temperatures
             above 40 deg C) and light.
    
             Hazardous Decomposition Products: Chlorine, oxygen, sodium
             chlorate.
    
             Incompatibility - Materials To Avoid:
    
                    Nitrogen Compounds (e.g., ammonia, urea, amines,
                    isocyanurates) -can form toxic, reactive chloramines.
                    When hypochlorite is in excess, nitrogen gas is
                    formed.
    
                    Ammonium Salts - form explosive nitrogen trichloride
                    if acid present.
    
                    Acids (especially hydrochloric acid HCl) - release
                    chlorine gas.
    
                    Methanol - can form methyl hypochlorite which can
                    explode.
    

                    Metals - some metals, especially copper, nickel and
                    cobalt, speed up the decomposition of NaOCl.
    
             Corrosivity to metals: Solutions are corrosive to many
             metals.

    4.  USES

        4.1  Uses

             4.1.1  Uses

             4.1.2  Description

                    Household sodium hypochlorite bleaches are
                    solutions of up to 10%, but are most commonly about
                    5%. They are used as general disinfectants and
                    bleaching agents. Sodium hypochlorite solutions often
                    contain other agents, including sodium hydroxide to
                    maintain a pH-dependent equilibrium between
                    hypochlorite and chlorine. Industrial bleaches may be
                    more concentrated (up to 50%).

        4.2  High risk circumstance of poisoning

             The ingestion of industrial bleaches may pose more of a
             risk because of additional chemicals or higher alkalinity.

        4.3  Occupationally exposed populations

    5.  ROUTES OF EXPOSURE

        5.1  Oral

             Ingestion  of the sodium hypochlorite solution can occur.

        5.2  Inhalation

             Exposure can occur to chlorine gas released from sodium
             hypochlorite solution after mixture with acid solutions.

        5.3  Dermal

             Exposure can occur to chlorine gas released from sodium
             hypochlorite solution and to the sodium hypochlorite solution
             itself.

        5.4  Eye

             Exposure can occur to chlorine gas released from sodium
             hypochlorite solution and to the sodium hypochlorite solution
             itself.


        5.5  Parenteral

             Unknown.

        5.6  Other

             Unknown.

    6.  KINETICS

        6.1  Absorption by route of exposure

        6.2  Distribution by route of exposure

        6.3  Biological half-life by route of exposure

        6.4  Metabolism

        6.5  Elimination and excretion

    7.  TOXICOLOGY

        7.1  Mode of action

             Sodium hypochlorite solution and chlorine gas are
             corrosive causing tissue necrosis.

        7.2  Toxicity

             7.2.1  Human data

                    7.2.1.1  Adults

                    7.2.1.2  Children

                             Most children who ingest sodium
                             hypoochlorite bleach swallow only small
                             amounts and suffer nothing more than vomiting
                             and gastrointestinal discomfort (Racioppi et
                             al., 1994). Pulmonary complications, such as
                             ARDS, usually resulting from aspiration,
                             often contribute to death.

             7.2.2  Relevant animal data

             7.2.3  Relevant in vitro data

             7.2.4  Workplace standards

             7.2.5  Acceptable daily intake (ADI)

        7.3  Carcinogenicity


        7.4  Teratogenicity

        7.5  Mutagenicity

        7.6  Interactions

    8.  TOXICOLOGICAL ANALYSES AND BIOMEDICAL INVESTIGATIONS

        8.1  Material sampling plan

             8.1.1  Sampling and specimen collection

                    8.1.1.1  Toxicological analyses

                    8.1.1.2  Biomedical analyses

                    8.1.1.3  Arterial blood gas analysis

                    8.1.1.4  Haematological analyses

                    8.1.1.5  Other (unspecified) analyses

             8.1.2  Storage of laboratory samples and specimens

                    8.1.2.1  Toxicological analyses

                    8.1.2.2  Biomedical analyses

                    8.1.2.3  Arterial blood gas analysis

                    8.1.2.4  Haematological analyses

                    8.1.2.5  Other (unspecified) analyses

             8.1.3  Transport of laboratory samples and specimens

                    8.1.3.1  Toxicological analyses

                    8.1.3.2  Biomedical analyses

                    8.1.3.3  Arterial blood gas analysis

                    8.1.3.4  Haematological analyses

                    8.1.3.5  Other (unspecified) analyses

        8.2  Toxicological Analyses and Their Interpretation

             8.2.1  Tests on toxic ingredient(s) of material

                    8.2.1.1  Simple Qualitative Test(s)


                    8.2.1.2  Advanced Qualitative Confirmation Test(s)

                    8.2.1.3  Simple Quantitative Method(s)

                    8.2.1.4  Advanced Quantitative Method(s)

             8.2.2  Tests for biological specimens

                    8.2.2.1  Simple Qualitative Test(s)

                    8.2.2.2  Advanced Qualitative Confirmation Test(s)

                    8.2.2.3  Simple Quantitative Method(s)

                    8.2.2.4  Advanced Quantitative Method(s)

                    8.2.2.5  Other Dedicated Method(s)

             8.2.3  Interpretation of toxicological analyses

        8.3  Biomedical investigations and their interpretation

             8.3.1  Biochemical analysis

                    8.3.1.1  Blood, plasma or serum
                             "Basic analyses"
                             "Dedicated analyses"
                             "Optional analyses"

                    8.3.1.2  Urine
                             "Basic analyses"
                             "Dedicated analyses"
                             "Optional analyses"

                    8.3.1.3  Other fluids

             8.3.2  Arterial blood gas analyses

             8.3.3  Haematological analyses

                    "Basic analyses"
                    "Dedicated analyses"
                    "Optional analyses"

             8.3.4  Interpretation of biomedical investigations

        8.4  Other biomedical (diagnostic) investigations and their 
             interpretation

        8.5  Overall interpretation of all toxicological analyses and 
             toxicological investigations


        8.6  References

    9.  CLINICAL EFFECTS

        9.1  Acute poisoning

             9.1.1  Ingestion

                    Gastrointestinal irritation, with nausea,
                    vomiting, is very common with ingestion of sodium
                    hypochlorite solution. Haematemesis may occur with
                    concentrated solutions. Household bleaches are
                    unlikely to cause severe irritation unless contact is
                    prolonged or the amount ingested is large. Severe
                    oesophageal damage may occur, but several reports have
                    concluded that it is not common (Pike et al., 1963;
                    Landau and Saunders, 1964).
    
                    Corrosive injury of the stomach (Van Rhee and
                    Beaumont, 1990; Strange et al., 1951) and
                    hypernatraemia with hyperchloraemic acidosis (Ward and
                    Routledge, 1988) have all been reported usually
                    following large intentional (Spiller et al., 1994)
                    ingestions by adults.

             9.1.2  Inhalation

                    Chlorine gas released from sodium hypochlorite
                    causes burning in the throat and coughing. High levels
                    of exposure can lead to swelling and obstruction of
                    the airway. In serious cases noncardiogenic pulmonary
                    oedema can occur.
    
                    Please see PIM on Chlorine

             9.1.3  Skin exposure

                    Exposure to high concentrated solutions can
                    result in serious corrosive burns.
    
                    Please see PIM on Chlorine

             9.1.4  Eye contact

                    Exposure to high concentrated solutions can
                    result in serious corrosive burns.
    
                    Please see PIM on Chlorine

             9.1.5  Parenteral exposure

             9.1.6  Other


        9.2  Chronic poisoning

             9.2.1  Ingestion

             9.2.2  Inhalation

             9.2.3  Skin exposure

             9.2.4  Eye contact

             9.2.5  Parenteral exposure

             9.2.6  Other

        9.3  Course, prognosis, cause of death

        9.4  Systematic description of clinical effects

             9.4.1  Cardiovascular

             9.4.2  Respiratory

             9.4.3  Neurological

                    9.4.3.1  Central nervous system (CNS)

                    9.4.3.2  Peripheral nervous system

                    9.4.3.3  Autonomic nervous system

                    9.4.3.4  Skeletal and smooth muscle

             9.4.4  Gastrointestinal

             9.4.5  Hepatic

             9.4.6  Urinary

                    9.4.6.1  Renal

                    9.4.6.2  Other

             9.4.7  Endocrine and reproductive systems

             9.4.8  Dermatological

             9.4.9  Eye, ear, nose, throat: local effects

             9.4.10 Haematological

             9.4.11 Immunological


             9.4.12 Metabolic

                    9.4.12.1 Acid-base disturbances

                    9.4.12.2 Fluid and electrolyte disturbances

                    9.4.12.3 Others

             9.4.13 Allergic reactions

             9.4.14 Other clinical effects

             9.4.15 Special risks

        9.5  Other

        9.6  Summary

    10. MANAGEMENT

        10.1 General principles

             Ingestion:
             Emesis is not recommended because of the risks associated
             with re-exposure of the oesophagus to the bleach. In the
             majority of cases the only treatment necessary is plenty of
             fluids, especially milk. Less than 5 mL/kg oral ingestion of
             a 7% solution is unlikely to cause severe effects. 
    
             Where a concentrated or highly alkaline solution has been
             ingested or the quantity swallowed is thought to be large,
             nasogastric aspiration of the stomach contents should be
             considered. Monitor the pH, sodium and chloride in severe
             cases. Symptomatic and supportive care with intravenous (IV)
             fluids for hypotension.
    
             The use of steroids and antibiotics in the management of
             corrosive injury is controversial and should be discussed
             with a poisons information service. Patients with suspected
             corrosive injury will require endoscopic examination to
             assess the extent of the damage.
    
             Inhalation:
             Patients without immediate symptoms may require no treatment,
             but a full physical examination and a record of respiratory
             peak flow may be of use in assessing any subsequent
             respiratory effects.
    
             Patients with mild effects:  require a full physical
             examination and peak flow and discharge accordingly, and
             advised to return if symptoms recur or develop over the
             following 24 to 36 hours.
    

             Patients showing immediate moderate or severe effects:  Check
             lung function and perform chest x-rays. Oxygen  and
             bronchodilators (e.g. salbutamol; orally or inhaled) are used
             for bronchospasm. Pulmonary oedema should be treated with
             Positive End Expiratory Pressure (PEEP), or Constant Positive
             Airway Pressure (CPAP). Corticosteroids may inhibit the
             inflammatory response and should be considered in severe
             cases. Monitor arterial blood gases, treat hyperchloraemic
             acidosis.
    
             Patients with pre-existing respiratory disease: assess and
             consider admission for at least 24 hours.
    
             Please see PIM on Chlorine
    
             Dermal: Wash thoroughly with running water or saline. Treat
             as a thermal burn, if necessary.
    
             Please see PIM on Chlorine
    
             Eyes: Irrigate thoroughly for 10 to 15 minutes. Refer to an
             ophthalmologist.
    
             Please see PIM on Chlorine

        10.2 Life supportive procedures and symptomatic/specific 
             treatment

             See section 10.1

        10.3 Decontamination

             Emesis is not recommended because of the risks
             associated with re-exposure of the oesophagus to the
             bleach.

        10.4 Enhanced elimination

             Not applicable.

        10.5 Antidote treatment

             10.5.1 Adults

                    No specific antidote available.

             10.5.2 Children

                    No specific antidote available.


        10.6 Management discussion

             The use of steroids and antibiotics in the management
             of corrosive injury is controversial and should be discussed
             with a poisons information service. Patients with suspected
             corrosive injury will require endoscopic examination to
             assess the extent of the damage.

    11. ILLUSTRATIVE CASES

        11.1 Case reports from literature

    12. Additional information

        12.1 Specific preventive measures

             Rescuers, first-aid personnel and medical professionals
             should use appropriate protective clothing/gloves and where
             necessary employ respiratory protection. 

        12.2 Other

    13. REFERENCES

        Landau GD and Saunders WH. (1964) The effect of chlorine
        bleach on the esophagus. Arch Otolaryngol 80:174-176
    
        Pike DG, Peabody JW, Davis EW and Lyons WS. (1963) A re-evaluation
        of the dangers of Clorox ingestion. J Pediatr 63 (2):303-305
    
        Racioppi F, Daskaleros PA, Besbelli N, Borges A, Deraemaeker C,
        Magalini SI, Martinez Arrieta R, Pulce C, Ruggerone ML and Vlachos
        P. (1994) Household bleaches based on sodium hypochlorite: review
        of toxicology and poison control center experience. Fd Chem
        Toxicol 32 (9):845-861
    
        Spiller HA, Ross MP and Nichols GR. (1994) Fatal caustic ingestion
        of sodium hypochlorite bleach with associated
        hypernatremic-hyperchloremic acidosis (abstract 139). Vet Hum
        Toxicol 36 (4):373
    
        Strange DC, Finneran JC, Shumacker HB and Bowman DE. (1951)
        Corrosive injury of the stomach. Report of a case caused by
        ingestion of Clorox and experimental study of injurious effects.
        Arch Surg 62:350-357
    
        Van Rhee F and Beaumont DM. (1990) Gastric stricture complicating
        oral ingestion of bleach. Br J Clin Pract 44 (11):681-682
    
        Ward MJ and Routledge PA. (1988) Hypernatraemia and
        hyperchloraemic acidosis after bleach ingestion.Hum Toxicol
        7:37-38


    14. AUTHOR(S), REVIEWER(S), DATE(S) (INCLUDING UPDATES), COMPLETE 
        ADDRESS(ES)

        Author:     Medical Toxicology Unit,
                    Guy's and St Thomas' Trust
                    Avonley Road, London SE14 5ER, UK
    
        Date:       December, 1997
    
        Review:     As for author. 1997
    
        Peer review:         INTOX meeting, March 1998, London, UK 
                             (Members of group: Drs G. Allridge, L.
                             Lubomovir, R. Turk, C. Alonso, S. de Ben, K.
                             Hartigan-Go, N. Bates)
    
        Editor:     Dr M.Ruse (September, 1998)
    



    See Also:
       Toxicological Abbreviations