1
|
Pai ARV. Injection of sodium hypochlorite into soft tissues of the oral cavity: A literature review with clinical preventive recommendations. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101581. [PMID: 37544507 DOI: 10.1016/j.jormas.2023.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.
Collapse
Affiliation(s)
- A R Vivekananda Pai
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia (MUCM), Jalan Batu Hampar, Bukit Baru, Melaka 75150, Malaysia.
| |
Collapse
|
2
|
Jeong JW, Sarmast ND, Terlier T, van der Hoeven R, Holland JN, Parikh N. Assessment of the cytotoxic effects and chemical composition of the insoluble precipitate formed from sodium hypochlorite and chlorhexidine gluconate. Int Endod J 2021; 54:1892-1901. [PMID: 34081782 DOI: 10.1111/iej.13583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/27/2022]
Abstract
AIM To investigate (1) the cytotoxic potential of the brown precipitate (BP) formed with sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX), using both a small animal model of Caenorhabditis elegans (C. elegans) and cultured human gingival fibroblasts; and (2) the chemical composition of BP using Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS). METHODOLOGY Brown precipitate was obtained by mixing equal volumes of 6% NaOCl and 2% CHX and separating the BP from clear supernatant by centrifugation. The brown precipitate was weighed and solubilized in dimethyl sulfoxide for cytotoxicity experiments. The cytotoxic effect of BP was assessed using C. elegans larvae and primary immortalized human gingival fibroblasts-hTERT (hTERT-hNOF) cells. Various dilutions of BP (25 ng/µL-150 ng/µL), supernatant (0.15% v/v), NaOCl (1:100-1:1000 dilutions of 6% NaOCl) or CHX (1:500-1:1000 dilutions of 2% CHX) along with vehicle control (0.5% v/v ethanol and 0.15% v/v DMSO) or untreated control (growth medium) were tested on C. elegans larvae and hTERT-hNOF cells. Viability was assessed in C. elegans larvae using stereomicroscopy and in hTERT-hNOF cells using dehydrogenase-based colorimetric assay. ToF-SIMS was used to assess the chemical composition of BP in comparison with CHX and para-chloroaniline (PCA). The C. elegans and cell line data were analysed using Log-Rank test and Student's t-test, respectively (p < .05). RESULTS BP-75 ng/µL and BP-150 ng/µL were significantly more toxic to C. elegans larvae than the untreated, vehicle, supernatant or CHX treatment groups (p < .0001). Similarly, in hTERT-hNOF cells, BP-50 ng/µL, BP-75 ng/µL and BP-150 ng/µL induced significant cytotoxicity within 2 h compared with untreated, vehicle, supernatant and CHX treatments (p < .05). ToF-SIMS analysis of BP revealed ion composition characteristic of both CHX and the carcinogen PCA. CONCLUSIONS Brown precipitate was toxic in both C. elegans larvae and hTERT-hNOF cells. The ToF-SIMS analysis of BP revealed ions characteristic of CHX and PCA that could account for the toxicities observed in C. elegans larvae and human gingival fibroblasts. Because of the insoluble and toxic nature of BP, consecutive use of CHX and NaOCl irrigants should be avoided in root canal treatment.
Collapse
Affiliation(s)
- Ji Wook Jeong
- Department of Endodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nima D Sarmast
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tanguy Terlier
- SIMS Laboratory, Shared Equipment Authority, Rice University, Houston, TX, USA
| | - Ransome van der Hoeven
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Julian N Holland
- Office of Research, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Neha Parikh
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
3
|
Daood U, Parolia A, Matinlinna J, Yiu C, Ahmed HMA, Fawzy A. Properties of a modified quaternary ammonium silane formulation as a potential root canal irrigant in endodontics. Dent Mater 2020; 36:e386-e402. [PMID: 33010944 DOI: 10.1016/j.dental.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Evaluate a new modified quaternary ammonium silane irrigant solution for its antimicrobial, cytotoxic and mechanical properties of dentine substrate. METHODS Root canal preparation was performed using stainless steel K-files™ and F4 size protaper with irrigation protocols of 6% NaOCl + 2% CHX; 3.5% QIS; 2% QIS and sterile saline. Biofilms were prepared using E. faecalis adjusted and allowed to grow for 3 days, treated with irrigants, and allowed to grow for 7 days. AFM was performed and surface free energy calculated. MC3T3 cells were infected with endo irrigant treated E. faecalis biofilms. Raman spectroscopy of biofilms were performed after bacterial re-growth on root dentine and exposed to different irrigation protocols and collagen fibers analysed collagen fibers using TEM. Antimicrobial potency against E. faecalis biofilms and cytoxicity against 3T3 NIH cells were also. Resin penetration and MitoTracker green were also evaluated for sealer penetration and mitochondrial viability. Data were analysed using One-way ANOVA, principal component analysis and post-hoc Fisher's least-significant difference. RESULTS Elastic moduli were maintained amongst control (5.5 ± 0.9) and 3.5% QIS (4.4 ± 1.1) specimens with surface free energy higher in QIS specimens. MC3T3 cells showed reduced viability in 6%NaOCl+2%CHX specimens compared to QIS specimens. DNA/purine were expressed in increased intensities in control and 6% NaOCl + 2% CHX specimens with bands around 480-490 cm-1 reduced in QIS specimens. 3.5% QIS specimens showed intact collagen fibrillar network and predominantly dead bacterial cells in confocal microscopy. 3.5% QIS irrigant formed a thin crust-type surface layer with cytoplasmic extensions of 3T3NIH spread over root dentine. Experiments confirmed MitoTracker accumulation in 3.5% treated cells. SIGNIFICANCE Novel QIS root canal irrigant achieved optimum antimicrobial protection inside the root canals facilitating a toxic effect against the Enterococcus faecalis biofilm. Root dentine substrates exhibited optimum mechanical properties and there was viability of fibroblastic mitochondria.
Collapse
Affiliation(s)
- Umer Daood
- Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Abhishek Parolia
- Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Jukka Matinlinna
- Dental Materials Science, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Cynthia Yiu
- Pediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong, China Hong Kong Special Administrative Region
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Amr Fawzy
- UWA Dental School, University of Western Australia, Nedlands, WA 6009, Australia
| |
Collapse
|
4
|
Yuan L, Lyu P, Huang YY, Du N, Qi W, Hamblin MR, Wang Y. Potassium iodide enhances the photobactericidal effect of methylene blue on Enterococcus faecalis as planktonic cells and as biofilm infection in teeth. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 203:111730. [PMID: 31855718 DOI: 10.1016/j.jphotobiol.2019.111730] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To explore the effectiveness, biosafety, photobleaching and mechanism of antimicrobial photodynamic therapy (aPDT) using methylene blue (MB) plus potassium iodide (KI), for root canal infections. METHODS Different combinations and concentrations of MB, KI and 660 nm LED light were used against E. faecalis in planktonic and in biofilm states by colony-forming unit (CFU), confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM). Human gingival fibroblasts (HGF) were used for safety testing by Cell Counting Kit-8 (CCK8) and fluorescence microscopy (FLM). The photobleaching effect and mechanisms were analyzed. RESULTS KI could not only enhance MB aPDT on E. faecalis in both planktonic and biofilm states even in a hypoxic environment, but also produced a long-lasting bactericidal effect after end of the illumination. KI could accelerate photobleaching to reduce tooth staining by MB, and the mixture was harmless for HGFs. Mechanistic studies showed the generation of hydrogen peroxide and free iodine, and iodine radicals may be formed in hypoxia. CONCLUSION aPDT with MB plus KI could be used for root canal disinfection and clinical studies are worth pursuing.
Collapse
Affiliation(s)
- Lintian Yuan
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Peijun Lyu
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Ying-Ying Huang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ning Du
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China; Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wei Qi
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China; Department of General Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa.
| | - Yuguang Wang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.
| |
Collapse
|
5
|
Accidental injection of ethylenediaminetetraacetic acid (EDTA) instead of an anaesthetic solution: a case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:77-79. [PMID: 30940531 DOI: 10.1016/j.jormas.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022]
Abstract
The accidental use of drugs is an unacceptable mistake in medicine, but the misuse of different agents has been reported frequently in the literature. While performing local anesthesia before starting dental treatment, the injection of a wrong agent, as a result of confusing the liquid in the syringe may cause local and systemic complications. Sudden swelling, intense pain, and severe allergic reactions may develop in the patient. A complication causing soft tissue necrosis is presented in this case report in which Ethylenediaminetetraacetic acid (EDTA) was accidentally injected instead of an anesthetic solution. This case report is unique because it is the first to report an inadvertent injection of EDTA in dentistry.
Collapse
|
6
|
Verma P, Tordik P, Nosrat A. Hazards of Improper Dispensary: Literature Review and Report of an Accidental Chloroform Injection. J Endod 2018; 44:1042-1047. [PMID: 29703617 DOI: 10.1016/j.joen.2018.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
Several clear, transparent solutions are used in endodontics. Inappropriate dispensing methods can lead to accidental injection or accidental irrigation. These accidents can cause permanent tissue damage including damage to the bone, periodontium, nerves, and vasculature. This article reports on the consequences of an accidental chloroform injection. Nonsurgical retreatment of tooth #8 was planned as part of a restorative treatment plan in a 69-year-old woman. The dentist accidentally injected chloroform instead of local anesthesia because chloroform was loaded into the anesthetic syringe. The patient experienced severe pain and swelling and soft tissue necrosis and suffered permanent sensory and motor nerve damage. A review of the literature was performed on accidents caused by improper dispensary, namely accidental injections and accidental irrigations. The data were extracted and summarized. Sodium hypochlorite, chlorhexidine, formalin, formocresol, 1:1000 adrenaline, benzalkonium chloride, and lighter fuel were accidentally injected as an intraoral nerve block or as infiltration injections. Bone and soft tissue necrosis, tooth loss, and sensory nerve damage (anesthesia and paresthesia) were the most common consequences reported. Such disastrous events can be prevented by appropriate labeling and separate dispensing methods for each solution. There is a need for disseminating information on toxicity and biocompatibility of materials/solutions used in endodontics. The authors recommend training dental students and endodontic residents on immediate and long-term therapeutic management of patients when an accidental injection or accidental irrigation occurs.
Collapse
Affiliation(s)
- Prashant Verma
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland.
| | - Patricia Tordik
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Ali Nosrat
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland; Iranian Center for Endodontic Research, Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Fu Q, Chen G, Liu Y, Cao Z, Zhao X, Li G, Yu F, Chen L, Wang H, You J. In situ quantification and evaluation of ClO−/H2S homeostasis in inflammatory gastric tissue by applying a rationally designed dual-response fluorescence probe featuring a novel H+-activated mechanism. Analyst 2017; 142:1619-1627. [DOI: 10.1039/c7an00244k] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A new dual-response probe for in situ quantification of ClO−/H2S homeostasis in inflammatory gastric tissue.
Collapse
|
8
|
Hongyan L, Jian X, Baorong Z, Yue J, Minhua L, Yilang L, Jing Z. [Accidental injection of sodium hypochlorite in inferior alveolar nerve block anesthesia]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:657-658. [PMID: 28318172 DOI: 10.7518/hxkq.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sodium hypochlorite (NaClO) has been widely used in clinical practice as one of the most efficient root canal irrigants. Its properties include broad-spectrum antimicrobial activity and ability to dissolve necrotic tissues. However, when used improperly, NaClO can cause a series of adverse reactions, such as mucosal inflammation, irritation, or injury. This paper presents a case of accidental injection of NaClO in inferior alveolar nerve block anesthesia.
Collapse
Affiliation(s)
- Li Hongyan
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China;School of Stomatology, Weifang Medical University, Weifang 261053, China
| | - Xu Jian
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| | - Zhang Baorong
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| | - Jia Yue
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| | - Liu Minhua
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| | - Luo Yilang
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| | - Zhao Jing
- Dept. of Dental Center, Aviation General Hospital of China Medical University, Beijing Institute of Translation Medicine, China Academy of Science, Beijing 100012, China
| |
Collapse
|
9
|
Regalado Farreras DC, Puente CG, Estrela C. Sodium Hypochlorite Chemical Burn in an Endodontist's Eye during Canal Treatment Using Operating Microscope. J Endod 2014; 40:1275-9. [DOI: 10.1016/j.joen.2014.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/08/2014] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
|
10
|
Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41:935-48. [PMID: 23994710 DOI: 10.1016/j.jdent.2013.08.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/12/2013] [Accepted: 08/17/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. METHODS To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. RESULTS By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. CONCLUSIONS Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
Collapse
|
11
|
Kilic E, Er N, Alkan A, Ferahbas A. Accidental benzalkonium chloride (zephiran) injection. ACTA ACUST UNITED AC 2011; 112:e103-5. [PMID: 22014998 DOI: 10.1016/j.tripleo.2011.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/18/2022]
Abstract
We report a case of an accidental injection of benzalkonium chloride (zephiran) instead of a local anesthetic agent during a tooth extraction. The sudden development of chin and neck swelling led to dyspnea and the patient lost consciousness. She was sent to an emergency clinic by her dentist immediately. After medical treatment for 20 days, the necrotic tissue was debrided and a gingival sulcoplasty was performed. Healing was uneventful.
Collapse
Affiliation(s)
- Erdem Kilic
- Erciyes University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kayseri, Turkey.
| | | | | | | |
Collapse
|
12
|
Katirci Y, Kandis H, Aslan S, Keles M, Cakir Z, Karcioglu O. Accidental Use of Sodium Hypochlorite Instead of Haemodialysis Solution: A Case Report. HONG KONG J EMERG ME 2010; 17:492-494. [DOI: 10.1177/102490791001700511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
Haemodialysis that involves diffusion of solutes across a semi-permeable membrane allows excretion of harmful solutes and excess fluids. All dialysis machines are disinfected by chemical agents (e.g. sodium hypochlorite, formaldehyde, glutaraldehyde, peroxyacetic acid). Sodium hypochlorite (NaOCl), which is known as household bleach, is a whitening agent and used in medical treatment and disinfection of tap water. Herein, we present a 66-year-old female patient who was inadvertently connected to NaOCl solution infusion in a routine haemodialysis session. By the time the accident was noticed, approximately 200 ml of undiluted NaOCl cleaning solution (concentration 1.21-1.23 g/ml) had been added to the dialysis bath, soaking the membrane fibres. The patient was admitted to the hospital about 30 minutes after the exposure, and her Glasgow Coma Scale score was recorded as 5/15 (E1, V1, M3). In conclusion, more stringent standards should be enforced in the sterilization of haemodialysis machines and related equipments. Accidental contacts with disinfectants should be prevented in dialysis units.
Collapse
Affiliation(s)
- Y Katirci
- Yozgat State Hospital, Emergency Service, Yozgat, Turkey
| | | | - S Aslan
- Atatürk University Medical Faculty, Emergency Medicine, Erzurum, Turkey
| | - M Keles
- Atatürk University Medical Faculty, Nephrology Department, Erzurum, Turkey
| | - Z Cakir
- Atatürk University Medical Faculty, Emergency Medicine, Erzurum, Turkey
| | - O Karcioglu
- Dokuz Eylul University Medical Faculty, Emergency Medicine, Izmir, Turkey
| |
Collapse
|
13
|
Aubut V, Pommel L, Verhille B, Orsière T, Garcia S, About I, Camps J. Biological properties of a neutralized 2.5% sodium hypochlorite solution. ACTA ACUST UNITED AC 2010; 109:e120-5. [DOI: 10.1016/j.tripleo.2009.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 09/01/2009] [Accepted: 09/10/2009] [Indexed: 11/25/2022]
|
14
|
|
15
|
Motta MV, Chaves-Mendonca MAL, Stirton CG, Cardozo HF. Accidental injection with sodium hypochlorite: report of a case. Int Endod J 2009; 42:175-82. [PMID: 19134046 DOI: 10.1111/j.1365-2591.2008.01493.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM A case is reported in which sodium hypochlorite (NaOCl) was mistaken for anaesthetic solution and infiltrated into the buccal mucosa during routine root canal treatment. SUMMARY A 1.5% sodium hypochlorite solution, kept in an anaesthetic cartridge, was inadvertently injected in the buccal mucosa of a 56-year-old female during routine root canal treatment. Soft tissue necrosis, labial ptosis and paraesthesia occurred shortly after the injection. Tissues healed with scarring and lip paraesthesia persisted for 3 years. KEY LEARNING POINTS * NaOCl is highly irritant when introduced into oral tissues. * NaOCl solutions should not be kept in anaesthetic cartridges. * Accidents with NaOCl should be carefully assessed and when appropriate active hospital treatment should be sought. * Early recognition of NaOCl accidents may avert potentially more serious outcomes.
Collapse
Affiliation(s)
- M V Motta
- Faculdade de Odontologia, Departamento de Odontologia Social, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
16
|
The Sodium Hypochlorite Accident: Experience of Diplomates of the American Board of Endodontics. J Endod 2008; 34:1346-1350. [DOI: 10.1016/j.joen.2008.07.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/22/2008] [Accepted: 07/27/2008] [Indexed: 11/19/2022]
|
17
|
Pontes F, Pontes H, Adachi P, Rodini C, Almeida D, Pinto D. Gingival and bone necrosis caused by accidental sodium hypochlorite injection instead of anaesthetic solution. Int Endod J 2008; 41:267-70. [DOI: 10.1111/j.1365-2591.2007.01340.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
A sudden death with lung embolism after inadvertent infusion of zinc oxide shake lotion. Forensic Sci Int 2007; 170:207-12. [DOI: 10.1016/j.forsciint.2007.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 03/16/2007] [Accepted: 03/17/2007] [Indexed: 11/16/2022]
|
19
|
HÜLSMANN MICHAEL, RÖDIG TINA, NORDMEYER SABINE. Complications during root canal irrigation. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1601-1546.2009.00237.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|