Antiseptics are applied to living tissue to kill or prevent the growth of microorganisms. Disinfectants are applied to inanimate objects to destroy pathogenic microorganisms. Despite the lack of rigorous evidence that they prevent infection, they are used widely in households, the food industry, and hospitals. This chapter describes toxicity caused by chlorhexidine, glutaraldehyde, hexylresorcinol, hydrogen peroxide, ichthammol, and potassium permanganate. These agents are often used as dilute solutions that usually cause little or no toxicity. Hexylresorcinol is commonly found in throat lozenges. Ichthammol is found in many topical salves. Descriptions of the toxicity of other antiseptics and disinfectants appear elsewhere in this book, including the following: hypochlorite, iodine, isopropyl alcohol, mercuric chloride and mercurochrome, phenol, and pine oil.

1. Chlorhexidine is commonly found in dental rinses, mouthwashes, skin cleansers, and a variety of cosmetics. Many preparations also contain isopropyl alcohol. Systemic absorption of chlorhexidine salts is minimal. Ingestion of products with a concentration less than 0.12% is not likely to cause more than minor irritation, but higher concentrations have caused corrosive injury.
2. Glutaraldehyde (pH 3-4) is used to disinfect medical equipment, as a tissue preservative, and topically as an antifungal and is found in some x-ray solutions. It is highly irritating to the skin and respiratory tract and has caused allergic contact dermatitis with repeated exposures.
3. Hexylresorcinol is related to phenol but is much less toxic, although alcohol-based solutions have vesicant properties.
4. Hydrogen peroxide is an oxidizing agent, but it is very unstable and readily breaks down to oxygen and water. Generation of oxygen gas in closed-body cavities can potentially cause mechanical distention that results in gastric or intestinal perforation, as well as venous or arterial gas embolization. Hydrogen peroxide is found in many dental products, including mouth rinses and tooth whiteners, skin disinfectants, hair products, and earwax removers, and it has many industrial uses. In veterinary medicine it is used to induce emesis.
5. Ichthammol (ichthyol, ammonium ichthosulfonate) contains about 10% sulfur in the form of organic sulfonates and is keratolytic to tissues.
6. Potassium permanganate is an oxidant, and the crystalline form and concentrated solutions are corrosive owing to the release of potassium hydroxide when potassium permanganate comes in contact with water.

1. Chlorhexidine ingestions of less than 4% are expected to cause irritation, and ingestion of 150 mL of 20% solution caused esophageal damage and hepatic injury.
2. The lethal dose of glutaraldehyde is estimated to be 5-50 g/kg. Topical application of 10% solutions can cause dermatitis, and 2% solutions have caused ocular damage.
3. Hexylresorcinol is used in some antihelminthics, in doses of 400 mg (for children age 1-7 years) to 1 g (older children and adults). Most lozenges contain only about 2-4 mg.
4. Hydrogen peroxide for household use is available in 3-5% solutions and causes only mild throat and gastric irritation with ingestion of less than 1 oz. However, gas embolization has occurred with low concentrations used in surgical irrigations. Concentrations above 10% are found in some hair-bleaching solutions and are potentially corrosive. Most reported deaths have been associated with ingestion of undiluted 35% hydrogen peroxide, marketed as “hyperoxygen therapy” in health food stores or “food grade” in industry.
5. Potassium permanganate solutions of greater than 1:5,000 strength may cause corrosive burns.

Most low-concentration antiseptic ingestions are benign, and mild irritation is self-limited. Spontaneous vomiting and diarrhea may occur, especially after a large-volume ingestion.

1. Exposure to concentrated antiseptic solutions may cause corrosive burns on the skin and mucous membranes, and oropharyngeal, esophageal, or gastric injury may occur. Glottic edema has been reported after ingestion of concentrated potassium permanganate.
2. Permanganate and chlorhexidine may also cause methemoglobinemia.
3. Hydrogen peroxide ingestion may cause gastric distension and, rarely, perforation. Severe corrosive injury and gas emboli have been reported with ingestion of the concentrated forms and may be caused by the entry of gas through damaged intestinal mucosa or possibly oxygen gas liberation within the venous or arterial circulation.

Is based on a history of exposure and the presence of mild GI upset or frank corrosive injury. Solutions of potassium permanganate are dark purple, and skin and mucous membranes are often stained brown-black.

1. Specific levels. Drug levels in body fluids are not generally useful or available. Isopropyl alcohol level by head-space gas chromatography is available at some toxicology laboratories.
2. Other useful laboratory studies include electrolytes, glucose, serum osmolality (for isopropyl alcohol exposure), methemoglobin level (for potassium permanganate or chlorhexidine exposure), and upright chest radiography (for suspected gastric perforation). CT scan may reveal portal venous or cerebral gas emboli from hydrogen peroxide.

1. Emergency and supportive measures
   1. In patients who have ingested concentrated solutions, monitor the airway for swelling and intubate if necessary.
   2. Consult a gastroenterologist for possible endoscopy after ingestions of corrosive agents such as concentrated hydrogen peroxide and potassium permanganate. Most ingestions are benign, and mild irritation is self-limited.
   3. Consider hyperbaric oxygen treatment for gas emboli associated with concentrated peroxide ingestion.
2. Specific drugs and antidotes. No specific antidotes are available for irritant or corrosive effects. If methemoglobinemia occurs, administer methylene blue.
3. Decontamination
   1. Ingestion of concentrated corrosive agents (see also)
      1. Dilute immediately with water or milk.
      2. Do not induce vomiting because of the risk for corrosive injury. Perform gastric lavage cautiously.
      3. Activated charcoal and cathartics are probably not effective. Moreover, charcoal may interfere with the endoscopist's view of the esophagus and stomach in cases of suspected corrosive injury.
   2. Eyes and skin. Irrigate the eyes and skin with copious amounts of tepid water. Remove contaminated clothing.
4. Enhanced elimination. Enhanced elimination methods are neither necessary nor effective.