Death after Ingestion of Surfactants: A particular Risk for Patients suffering from Dementia

Case Report: In a state of mental confusion, a 79-year-old male ingested ca. 200 mL of a detergent containing surfactants at his home. Despite cardiopulmonary resuscitation (CPR), the patient died at the hospital within 60 minutes, from lung oedema. Manifestations/Course: The mentally disabled patient had been staying at home alone during daytime. He had been attended once a day by a home care service and, in the mornings and evenings, by his relatives. He was found in the evening on his couch by his son, who noticed a "strange manner of speaking." The open bottle of the detergent and a cup with remains of the detergent were found on the floor. The quantity ingested amounted to about 200 mL. On his immediate admission to hospital, the patient was awake but did not show any adequate reaction. He suffered from pronounced dyspnoea and bubbling crepitation over the lung fields. Respiratory and circulatory arrest set in within ten minutes. The patient died in spite of CPR including suction, intubation and adrenaline (epinephrine) administration. No post-mortem was performed. Measures: Measures taken so far. On account of a considerable number of accidents involving surfactant-containing products as well as other household products and disinfectants, the BfR Documentation Centre for Poisonings (BfRDocCentre) conducted an expert hearing involving representatives of nursing and consumers' associations, of the industry and the Poison Control Centres in November 2001 under the responsibility of the predecessor institution of the BfR, the Federal Institute for Health Protection of Consumers and Veterinary Medicine (BgVV). The aim of the hearing was to point out the background of such accidents and to develop strategies for their prevention. We therefore placed special emphasis on the problem of accidental ingestion by elderly and disoriented persons. In parallel, corresponding press releases were issued. In the context of the press releases, 12,000 information leaflets in the German, Turkish, Russian, Serbian/Croatian and Polish languages were distributed to hospitals and day-care institutions. Conclusions: Since 1995, in the age groups over 65 years, the number of the documented cases of severe health impairment after ingestion of products containing surfactants in the BfRDocCentre has increased to 16, including as many as 14 deaths. In 2003 and 2004, however, no severe cases were reported to the BfR, possibly as a consequence of appropriate instructions given to nursing and cleaning staff. In 2005 and 2006, there were unfortunately two additional serious cases of aspiration in elderly people. The BfR will place special emphasis for a second time on the problem of accidental ingestion by elderly and disoriented persons.