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Trisodium phosphate poisoning

Sodium orthophosphate poisoning; Trisodium orthophosphate poisoning; TSP poisoning

Trisodium phosphate is a strong chemical. Poisoning occurs if you swallow, breathe in, or spill large amounts of this substance on your skin.

This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

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Poisonous Ingredient

Trisodium phosphate

Where Found

These products may contain trisodium phosphate:

• Some automatic dishwashing soaps
• Some toilet bowl cleaners
• Many industrial solvents and cleaners (hundreds to thousands of construction agents, flooring strippers, brick cleaners, cements, and many others)

Other products also contain trisodium phosphate.

Symptoms

Below are symptoms of trisodium phosphate poisoning or exposure in different parts of the body.

AIRWAYS AND LUNGS

• Breathing difficulty (from inhaling trisodium phosphate)
• Coughing
• Throat swelling (which may also cause breathing difficulty)

ESOPHAGUS, STOMACH AND INTESTINES

• Blood in the stool
• Burns of the esophagus (food pipe) and stomach
• Diarrhea
• Severe abdominal pain
• Vomiting, possibly bloody

EYES, EARS, NOSE, AND THROAT

• Drooling
• Severe pain in the throat
• Severe pain or burning in the nose, eyes, ears, lips, or tongue
• Vision loss

HEART AND BLOOD

• Low blood pressure (develops rapidly)
• Collapse
• Severe change in blood acid level
• Shock

SKIN

• Burns
• Hives
• Holes in the skin or tissue under the skin
• Skin irritation

Home Care

Seek medical help right away. Do not make a person throw up unless the poison control or a health care provider tells you to.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, give the person water or milk right away. Do not give water or milk if the person has symptoms that make it hard to swallow (such as vomiting or decreased alertness).

If the person breathed in the poison, move them to fresh air right away.

Before Calling Emergency

Have this information ready:

• The person's age, weight, and condition
• The name of the product (ingredients and strength, if known)
• The time it was swallowed
• The amount swallowed

Poison Control

The local poison control 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 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.

You can also get online poison help now at Poisonhelp.org. Just enter the product, poison, or medicine to get expert help.

What to Expect at the Emergency Room

Take the container with you to the hospital, if possible.

Treatment depends on how the poisoning occurred. Your provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. Pain medicines will be given.

For swallowed poison, you may receive:

• Endoscopy (involves placing a tiny flexible camera into the throat to see burns in the esophagus and the stomach)
• Chest x-ray
• Electrocardiogram (ECG)
• Fluids by IV (through a vein)
• Medicines to treat symptoms

For inhaled poisons, the person may receive:

• Breathing support, including oxygen, or a tube that goes through the mouth into the lungs, and attachment to a breathing machine (ventilator)
• Bronchoscopy (involves placing a tiny flexible camera into the throat to see burns in the airways and lungs)
• Chest x-ray
• Electrocardiogram (ECG or heart tracing)
• Fluids by IV (through a vein)
• Medicine to treat symptoms

For skin exposure, the person may receive:

• Skin debridement (surgical removal of burned skin)
• Washing of the skin (irrigation) every few hours for several days
• Ointments applied to the skin

For eye exposure, the person may receive:

• Extensive irrigation to flush out the poison
• Medicines

Outlook (Prognosis)

How well a person does depends on the amount of poison exposure (swallowed, inhaled, on the skin, or in the eyes) and how quickly treatment was received. The faster a person gets medical help, the better the chance for recovery.

Severe damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible. The long-term outcome depends on the extent of this damage. Damage to the esophagus and stomach continues to occur for several weeks after the poison was swallowed. Death may occur as long as a month later.

Keep all poisons in their original or childproof container, with labels visible, and out of the reach of children.

References

Abel MK, Murase JE. Irritant contact dermatitis. In: Lebwohl MG, Heymann WR, Coulson IH, Murrell DF, eds. Treatment of Skin Disease. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 115.

Hoyte C. Caustics. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 143.

Nelson LS, Calello DP. Acute poisoning. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 96.

Review Date: 4/8/2025  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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