ACEP: Don't Drink the Fabuloso!

NEW ORLEANS Oct. 17 -- A brightly colored, attractively packaged household cleaning product called Fabuloso has led to a rash of emergency department visits for accidental ingestion, reported toxicology researchers here.

In less than four months, the Texas Poison Center recorded 112 cases of accidental ingestion of Fabuloso, apparently because consumers mistook it as something good to drink, a sports beverage, for instance.

So reported Michael A. Miller, M.D., of the Darnall Medical Center in Fort Hood, Tex., at the American College of Emergency Physicians meeting here. Fortunately, he and colleagues added, the product is only a mild gastrointestinal irritant and is unlikely to cause any serious illness. One of the authors even tasted it, and found it "fruity with a pleasing aroma," but with a bitter aftertaste.

"Apparently it's a very good cleaning product," said co-author Marc E. Levsky. M.D. "The issue with it is that it looks like a fruit beverage. It has a nice purple or orange color. It comes in a bunch of different colors, or aromas, and it's packaged in a bottle that makes it look like Gatorade or Powerade."

In an interview, Dr. Levsky said that the problem of look-alike poisonings is not too common, and is seen less frequently than accidental ingestion of over-the-counter medications such as Tylenol or aspirin.

The maker of Fabuloso, Colgate-Palmolive, has said that it is altering the packaging in response to public concerns.

"Exposure to this is very benign," Dr. Levsky said. "The worst that could happen if they drank a good bit of this is that they'd get diarrhea. It really is considered to be a very safe product."

The Darnall team conducted a study of all calls about Fabuloso that were made to the Texas Poison Center Network call center from Jan. 1 to April 20 this year. Using the center's database, they extracted information about the total number of calls, reason for ingestion, and age and gender of the patients.

They identified 112 records, including 104 human exposures, four animal exposures and four calls for information only. Among the 104 human exposures, 94 of the ingestions were unintentional, two were listed as occupational, four were self-harm related, one was intentional for unspecified reasons, and one was deemed malicious. Ten other cases of exposure were not characterized.

Among 47 females exposed, 15 were younger than six years old, one was from six to 12, 29 were older than 20, and six of the adults were older than 60. Among the 57 men and boys exposed, 45 were under age six, one was from six to 12, 10 were older than 20, and three of these were older than 60.

"The impact upon the person accidentally consuming this product or a similarly relatively benign cleaning product is unclear," the authors wrote. "While poison center personnel and physicians might recognize this as a benign ingestion, family members and the confused callers/patients might consider this a significant event at worst and an inconvenience at best. Our study demonstrates that this product is not infrequently ingested due to a probable case of mistaken identity, with a vast majority of calls occurring after accidental exposure."