I recently cared for a child who was poisoned after biting into a laundry detergent pod. I've also heard that some teenagers have been harmed by doing the same thing intentionally. What makes these pods so attractive-and dangerous?-R.B., COLO.

M. Thomas Quail, MS Ed, RN, LNC, replies: Laundry detergent pods are single-use products containing premeasured ultraconcentrated liquid detergent encased in a water-soluble packet.1,2 The detergent accounts for 90% of the pod; the remaining 10% is water. Because these multicolored pods resemble candy, toys, or teething products, some children have bitten into or ingested them accidentally.3-6 Ingestion or other exposure to the pod's contents can cause potentially serious adverse reactions such as vomiting, aspiration, cardiac dysrhythmias, pulmonary edema, respiratory distress, dermal and ocular caustic burns, seizures, and alterations in level of consciousness including coma.1-13 Two pod-related fatalities have been reported in toddlers.3-6

The American Association of Poison Control Centers (AAPCC) reports that toddler exposure to all poisonous substances constitutes over 45% of its annual U.S. call volume. AAPCC defines an exposure as contact with a substance by way of ingestion, inhalation, dermal or ocular contact, or other means. Not all exposures are poisonings or considered an overdose.7 From 2013 to 2017, annual laundry pod exposures have ranged from 10,145 to 12,616 cases.8,9

Besides these accidental exposures, the AAPCC reports a dramatic annual increase in intentional adolescent pod exposures. Fifty-three of these intentional adolescent exposures were reported in 2017. In the first 2 months of 2018, 196 adolescents intentionally exposed themselves to laundry pods.7,10

This increase in adolescent exposures has been attributed to social media platforms on the Internet promoting the so-called "Tide Pod Challenge," which encourages adolescents to bite or ingest a pod, video the associated effects, and post the videos over social media platforms.5,6,9 The AAPCC, CDC, Consumer Product Safety Commission, and state poison control centers have all issued warnings against this dangerous practice, calling it an emerging public health concern.6,9,10,13

Proctor & Gamble (PG), the manufacturer of Tide products, has issued multiple consumer alerts over various media platforms and has promoted public service announcements denouncing the Tide Pod Challenge and warning of its dangers.1,6,10 Recently PG added a bittering agent to the pods to dissuade people from ingesting them. They've also partnered with Facebook and YouTube to remove Tide Pod Challenge posts because such posts encourage behavior that may lead to injury or death.1,6,7

If anyone has ingested or is suspected of ingesting a pod, immediately contact the National Poison Help Hotline at 1-800-222-1222 for treatment guidelines from a poison control center expert. For more information, go to http://www.poison.org.

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