1. Bleach is not sodium hydroxide

    I have seen now that a correction was asserted. It is not satisfactory on its face for two reasons.

    The first is that my criticism of the report was not acknowledged for pointing out that the original claim was of swallowing a bleach tablet, which meant that treatment could be understood as inappropriate or inadequate.

    The second is that a "correction" that ascribed the problem as that the patient ingested a 3.5g(!) tablet (!) of sodium hydroxide clarifies little or nothing.

    1. Sodium hydroxide does not appear as "tablets" in any pharmacopoeia of which I am aware. I will withdraw my objection if there is such with documented reference. 2. The article still refers to the treatment of bleach ingestion without addressing the chlorine content thereof, thus misunderstanding the key point I made in my previous email, and misses the value I brought to the discussion. 3. "Prilled" sodium hydroxide, the only type of lye of which I am aware might remotely be thought a "tablet" is typically 0.1 g in size, not 3.5g (35 times a prilled version!). Nor would such a material be near the counter of a random patient where it might be mistaken for a tablet (if I may hone the point a bit).

    I believe that there should be more explained about this unfortunate event, that my email should be published for consideration by other experts, and that the modality of treatment should be better addressed by the physicians.

    Conflict of Interest:

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  2. Bleach is not sodium hydroxide

    The article starts as a report of ingestion of sodium hydroxide tablet and all but one reference within it is to sodium hydroxide.

    The single reference to bleach is the reason for my letter. It is not clear to me that anyone would have large tablets of sodium hydroxide (usu prilled pellets are <<1g), and I confess that solid bleach tablets are not an item I have used. I presume such would be to sanitize a dishwasher.

    That said, sodium hypochlorite (bleach) has a pKa of ~7.5, so a reference to the pKa of sodium hydroxide may not be warranted.

    There is no doubt that solid bleach would do what was described, imo, but some of the complications (lung irritation eg)may have arisen from the release of chlorine (if it was indeed bleach the patient ingested), and the concomitant inhalation.

    I thought clarification would be useful, and that the potential for chlorine ingestion/inhalation might be discussed by the physicians to keep in mind should such a case arise again.

    Conflict of Interest:

    None declared

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