What is ink poisoning

Writing ink poisoning occurs when someone accidental or intentional swallows ink found in writing instruments (pens). The exposure may also occur following skin or eye contact. Get medical help right away. Do not make a person throw up unless told to do so by the poison center or a health care professional.

Large amounts of writing ink must be consumed (more than an ounce or 30 milliliters) before treatment is needed.

Writing ink is a complex mixture of pigments and dyes that is available in liquid, paste, or even powder form. There are a variety of inks depending on the requirement – whether to write down class notes or for printing newspapers and magazines. In general, ink is a blend of dyes and pigments that may contain certain heavy metals, organic compounds and petroleum-based oils.

Writing ink is a blend of:

• Dyes
• Pigments
• Solvents
• Water

Writing ink is generally considered nonpoisonous. The person may not need to be treated in a hospital.

Toxicity of tattoo inks has been the subject of little research and ink manufacturers are not obliged to disclose the exact composition of their products ¹. Published research has reported that some inks contain pigments used in printer toner or in car paint. The U.S. Food and Drug Administration (FDA) has not approved any pigments for injection into the skin for cosmetic purposes. The U.S. Food and Drug Administration (FDA) is also seeing reports of people developing infections from contaminated tattoo inks, as well as adverse reactions to the inks themselves ². Over the years, the FDA has received hundreds of adverse event reports involving tattoos: 363 from 2004-2016. There’s no sure-fire way to tell if the tattoo ink is safe. An tattoo ink can be contaminated even if the container is sealed or the label says the product is sterile. Inks and kits sold as “do-it-yourself” to consumers have been associated with infections and allergic reactions. FDA is also concerned that consumers may not know how to control and avoid all sources of contamination.

Poisoning by a mixture of henna dye and para-phenylenediamine dyes led to the hospitalization of 31 Sudanese children between 1984 and 1989 ³. There was a characteristic clinical presentation. All children presented with an acute and severe angioneurotic edema and 15 of the cases required emergency tracheostomy for respiratory obstruction. Acute renal failure occurred in five children who recovered after peritoneal dialysis. Mortality was high, all 13 deaths occurring within 24 hours of presentation. Hypotensive shock gave a poor prognosis. It is possible that similar cases may be occurring unrecognized where henna is traditionally used. Ingestion was accidental in 12 children, deliberate in 10 and homicidal in three cases. Cutaneous absorption was likely in the remaining six ³.

Ink poisoning symptoms

Ink poisoning symptoms include:

• Eye irritation if the ink gets in your eye
• Staining of skin and mucous membranes insides of your mouth
• Headaches
• Nausea
• Vomiting
• Consuming significant amounts of ink, especially printing ink, can result in severe symptoms affecting the central nervous system

Tattoo ink poisoning symptoms

You might notice a rash—redness or bumps—in the area of your tattoo, and you could develop a fever.

More aggressive infections may cause high fever, shaking, chills, and sweats. Treating such infections might require a variety of antibiotics—possibly for months—or even hospitalization and/or surgery. A rash may also mean you’re having an allergic reaction. And because the inks are permanent, the reaction may persist. Contact your health care professional if you have any concerns.

Scar tissue may form when you get a tattoo, or you could develop “granulomas,” small knots or bumps that may form around material that the body perceives as foreign. If you tend to get keloids—scars that grow beyond normal boundaries—you may develop the same kind of reaction to the tattoo.

Some people may have swelling or burning in the tattoo when they have magnetic resonance imaging (MRI), although this happens rarely and does not last long. Let your health care professional know that you have a tattoo before an MRI is ordered.

Could other problems occur later on?

Although research is ongoing at FDA and elsewhere, there are still a lot of questions about the long-term effects of the pigments, other ingredients, and possible contaminants in tattoo inks. FDA has received reports of bad reactions to tattoo inks right after tattooing and even years later. You also might become allergic to other products, such as hair dyes, if your tattoo contains p-phenylenediamene (PPD).

Then there’s tattoo removal. Scientists don’t know the short- or long-term consequences of how pigments break down after laser treatment. However, theye do know some tattoo removal procedures may leave permanent scarring.

Remember, too, that removing a tattoo is a painstaking process, and complete removal without scarring may be impossible.

Ink poisoning treatment

Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does not need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

At the emergency department, your health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. Your doctor may wash your eyes or skin to remove the ink.

How well the person does depends on the amount of poison swallowed and how quickly treatment is received. The faster the person gets medical help, the better the chance for recovery.

Because writing ink is generally considered nonpoisonous, recovery is very likely.

Gastric lavage

In most situations, gastric lavage is preferable to administration of ipecac, particularly in emergency departments where prolonged ipecac-induced vomiting may delay treatment with activated charcoal ⁴. Indications for lavage include ingestions of highly toxic substances (large ingestions or substances associated with high morbidity and/or mortality); substances not well adsorbed by activated charcoal (i.e., lithium, iron, lead, methanol) and in patients with the potential for a jeopardized airway (e.g., altered alertness) ⁵.

Contraindications to gastric lavage include ingestion of corrosives and most hydrocarbons (gastric emptying is indicated after ingestions of hydrocarbon products containing benzene, toluene, camphor, halogenated hydrocarbons, pesticides or heavy metals, or if the ingestion was greater than 4 to 5 mL per kg); patients with depressed gag reflexes who are not intubated and clinically insignificant ingestions ⁴. Complications include aspiration, and perforation of the esophagus or bronchus. A 28- to 36-in French tube is suitable for use in children; a 36- to 40-in French tube is suitable for use in adults ⁶.

Gastric lavage is accomplished in children using normal saline or tap water in 15 mL per kg aliquots until clear.3 Lavage in adults uses 300 mL aliquots until clear, up to 10 to 20 L, if necessary. Administration of activated charcoal through the lavage tube before and after lavage may be beneficial in patients with potentially fatal ingestions ⁴.

Ipecac

Ipecac continues to be useful in the telephone management of alert patients unable to travel to a health care facility within one hour of the ingestion ⁴. It has been shown that ipecac used at home by experienced hospital staff treating pediatric poisonings following ingestions identified as not being “high-risk” decreases pediatric emergency department visits without jeopardizing safety ⁷.

Syrup of ipecac is administered in the following dosages: in infants six months to one year of age, 10 mL; in children one to 12 years of age, 15 mL; in adolescents over 12 years of age, 30 mL. Water is given immediately after the ipecac to enhance the efficacy of gastric emptying with emesis; adults should receive 8 to 16 oz; children should receive 4 to 8 oz; children less than one year of age should receive 5 to 15 mL per kg body weight ⁴.

Ipecac should not be given to children who are less than six months of age, patients who are already vomiting, patients with altered mental status or impaired gag reflexes, and patients who have ingested medications that cause seizures or decreased responsiveness ⁴. Use of ipecac should be avoided following ingestion of corrosives (acids or alkalis), sharp objects, most hydrocarbons (similar to gastric lavage) or when treatment with activated charcoal is anticipated within 60 to 90 minutes ⁴.

Activated charcoal

Activated charcoal forms the mainstay of gastric decontamination and is effective for most oral poisonings when given alone or following gastric emptying ⁴. Exceptions include ingestions of caustic acids and alkalis, alcohols, lithium and heavy metals (e.g., iron, arsenic). Activated charcoal is inert and remains within the gastrointestinal tract, offering a large surface area for adsorption of ingested toxins. In addition, activated charcoal may decrease the absorption of drugs that undergo enterogastric or enterohepatic circulation.

The usual dosage is 1 to 2 g per kg for children and adults, usually given as a single dose combined with a cathartic ⁴. The charcoal is mixed with water in a ratio of 1:4 to 1:8 (1 part charcoal to 4 or 8 parts water) to form a slurry; small quantities of fruit juice or chocolate powder can improve the taste. Multiple dosing (1 g per kg every two to six hours) has been shown to be effective for poisonings with phenobarbital, phenytoin (Dilantin), carbamazepine (Tegretol), salicylates, digitalis, theophylline and dapsone.12,15–17 When multiple dosing is used, a cathartic can be given with the first dose but should not be administered with subsequent doses because of the potential for serious fluid and electrolyte abnormalites. Contraindications to activated charcoal use include mechanical bowel obstruction and ileus.

Whole bowel irrigation

Whole bowel irrigation uses isosmotic cathartic solutions to flush and cleanse the bowel ⁴. It is potentially beneficial in patients who have ingested substances that are not well-absorbed by activated charcoal and/or are not amenable to lavage. Examples of such substances include iron, lithium and slow-release potassium, and packets or vials containing cocaine and other drugs. Commonly used irrigants (Golytely, Colyte) contain a polyethylene glycol electrolyte solution that is not absorbed from the gastrointestinal tract and does not cause significant fluid or electrolyte imbalances. The solution is administered orally or through a nasogastric tube at the rate of 2 L per hour in adults and 0.5 L per hour (or 25 to 40 mL per kg per hour) in children until the rectal effluent is clear ⁸. Patients tolerate the procedure best when alert and sitting on a commode; supine patients are best managed by placing a rectal tube. Contraindications to whole bowel irrigation include mechanical obstruction, ileus, perforation and gastrointestinal bleeding ⁴.

References

1. Grant CA, Twigg PC, Baker R, Tobin DJ. Tattoo ink nanoparticles in skin tissue and fibroblasts. Beilstein J Nanotechnol. 2015;6:1183-91. Published 2015 May 20. doi:10.3762/bjnano.6.120 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464189/
2. Think Before You Ink: Are Tattoos Safe? https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048919.htm
3. Poisoning from henna dye and para-phenylenediamine mixtures in children in Khartoum. Ann Trop Paediatr. 1992;12(1):3-6. https://www.ncbi.nlm.nih.gov/pubmed/1376583
4. Oral Poisonings: Guidelines for Initial Evaluation and Treatment. Am Fam Physician. 1998 Jan 1;57(1):85-92. https://www.aafp.org/afp/1998/0101/p85.html
5. Phillips S, Gomez H, Brent J. Pediatric gastrointestinal decontamination in acute toxin ingestion. J Clin Pharmacol. 1993;33:497–507.
6. Herrington AM, Clifton GD. Toxicology and management of acute drug ingestions in adults. Pharmacotherapy. 1995;15:182–200.
7. Bond GR. Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits. Ann Emerg Med. 1995;25:338–43.
8. Perrone J, Hoffman RS, Goldfrank LR. Special considerations in gastrointestinal decontamination. Emerg Med Clin North Am. 1994;12:285–99.