Diagnostic challenges in surfactant poisoning: A case of dishwashing detergent ingestion in a dementia patient.

Abstract

Household product ingestion in elderly dementia patients poses diagnostic challenges due to unreliable history and nonspecific presentations. An 88-year-old woman with dementia living alone presented with shock, respiratory distress, altered consciousness, and profuse diarrhea. Initial evaluation revealed bilateral pulmonary congestion, gastrointestinal edematous changes, metabolic acidosis, and elevated white cell count. Despite treatment for presumed septic shock secondary to pneumonia and enteritis, and cardiac deterioration, persistent symptoms complicated the diagnosis. On day 6, the family discovered opened orange dishwashing detergent in her refrigerator, leading to surfactant poisoning diagnosis. The patient was treated supportively with fluid management and antibiotics, achieving favorable outcomes. This case highlights diagnostic difficulties when dementia patients present with unexplained systemic illness. Clinicians should consider household product poisoning in elderly patients with cognitive impairment, particularly those living alone. Modern detergent packaging resembling beverages increases ingestion risk. Family involvement in environmental assessment and history-taking is crucial for accurate diagnosis in this vulnerable population.