Sodium Hypochlorite

Toxicological Overview

Key Points
Health effects of acute exposure
 ingestion of sodium hypochlorite may cause burns to the mouth and throat,
gastrointestinal irritation, nausea, vomiting and diarrhoea
 inhalation and ocular exposure to chlorine gas, produced when sodium hypochlorite is
mixed with acidic or alkaline solutions, results in burning of throat and lungs, eye and
nose irritation, chest tightness, coughing and sore throat
 exposure to higher concentrations of chlorine may lead to tachypnoea, cyanosis, swelling
of the airway and, in severe cases, pulmonary oedema and respiratory failure
 sodium hypochlorite is corrosive and may irritate the skin or cause burning pain,
inflammation and blisters
 ocular exposure may cause irritation, pain, lacrimation, photophobia and retinitis

Health effects of chronic exposure

 chronic skin exposure may cause skin irritation, pain, inflammation and blisters
 the International Agency for Research on Cancer (IARC) classified sodium hypochlorite
as a category 3 carcinogen, ie not classifiable as to the carcinogenicity to humans
 sodium hypochlorite is not considered to be a reproductive toxin

PHE publications gateway number: 2014790

Published: May 2015
 Compendium of Chemical Hazards: Sodium Hypochlorite

Summary of Health Effects

Sodium hypochlorite itself may be toxic if ingested, or by dermal or ocular exposure. If mixed
with acidic solutions chlorine gas is produced, and mixing with ammonia-based solutions
gives rise to chloramine solution, both of which contribute to toxic effects.

Ingestion of small volumes of sodium hypochlorite causes burns to the mouth and throat,
gastrointestinal irritation, nausea and vomiting. Ingestion of any amount of industrial strength
bleach (>10% sodium hypochlorite) or large amounts (approximately 300 mL in adults;
100 mL in children) of household bleach (<10% sodium hypochlorite) may cause abdominal
and retrosternal pain and diarrhoea. Aspiration of liquid may lead to pulmonary complications
such as acute respiratory distress syndrome (ARDS).

Inhalation of chlorine gas causes burning of the throat and lungs, eye and nose irritation,
chest tightness and coughing. At higher levels of exposure, tachypnoea, cyanosis and
swelling of the airway may occur. Pulmonary oedema and respiratory failure may arise in
severe cases, the onset of which may take up to 36 hours.

Sodium hypochlorite is corrosive and may irritate the skin or cause burning, pain,
inflammation and blisters. Ocular exposure can cause irritation, pain, lacrimation and
photophobia.

Hypochlorite salts have been classified as group 3 by the International Agency for Research
on Cancer (IARC), ie compounds that are not classifiable as to their carcinogenicity
in humans.

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Sources and Route of Human Exposure

In children the main route of exposure to sodium hypochlorite solution is by accidental
ingestion, while in adults ingestion is relatively rare. In adults, inhalation of gases formed by
the mixing of sodium hypochlorite with acidic or alkaline solutions is the most frequent route
of exposure. Dermal or ocular exposure may also occur [1-3].

Sodium hypochlorite is commonly used as a general disinfectant and bleaching agent.

Household bleach may contain up to 10% sodium hypochlorite, while industrial bleaches
may be more concentrated (up to 50%) [2]. Due to inappropriate mixing of domestic cleaning
products or incorrect use of swimming pool disinfectants, accidental domestic exposures to
chlorine are relatively common.

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 Compendium of Chemical Hazards: Sodium Hypochlorite

Health Effects of Acute/Single Exposure

Human data
General toxicity
Although sodium hypochlorite solution itself is only moderately toxic, it liberates chlorine gas
when acidified, eg if mixed with acidic cleaning agents. Mixing sodium hypochlorite with
ammonia-based solutions gives rise to chloramine compounds. Both chlorine and
chloramines are strong respiratory irritants hence contribute to toxic effects [1, 3, 4].

Symptoms of sodium hypochlorite exposure may be immediate, or may be delayed for

several hours [4].

Inhalation
Intoxication following the inhalation of sodium hypochlorite vapours is extremely rare as
chlorine gas is not released by bleach solutions in appreciable amounts under normal
conditions. The toxicity of sodium hypochlorite solution by inhalation is predominantly due to
the mixing of bleach with acids and the release of highly irritant gases [1]. Metabolic acidosis
may occur in rare cases following significant inhalation of sodium hypochlorite [5].

Mixing sodium hypochlorite with acids releases chlorine gas, although in most cases the
concentration of chlorine liberated is not sufficient to cause adverse health effects. In rare
cases, inhalation of chlorine gas, produced from mixing sodium hypochlorite with acid,
causes immediate burning of the throat and lungs, eye and nose irritation, chest tightness,
coughing, sore throat, wheezing and dyspnoea [3-5]. In severe cases, bronchospasm,
pneumonitis, upper airway oedema, pulmonary oedema or oedema of the glottis may
develop [5].

Mixing sodium hypochlorite with ammonia-based solutions results in the formation of

monochloramine and dichloramine, both of which are respiratory irritants [4].

In most cases respiratory irritation occurs immediately, followed by a latent period of

5 minutes to 15 hours, after which time breathlessness and bronchospasm may occur [1]. In
most cases symptoms are usually resolved in 1–4 weeks [4, 6]. However, in some instances
pulmonary damage may lead to long-term reactive airways dysfunction syndrome (RADS), a
chemical irritant-induced type of asthma following an acute respiratory exposure to an irritant
gas [3, 6]. In addition, ARDS as a result of pneumonitis, has been reported in patients
following inhalation of chlorine following the mixing of bleach and other hydrochloric acid [5,
6].

Ingestion
At low concentrations (up to 10%), such as those used for household bleach, sodium
hypochlorite is a mild to moderate irritant that rarely produces necrosis or significant mucosal
injury. Ingestion is not expected to cause severe or permanent damage of the

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gastrointestinal tract and recovery is usually rapid. At higher concentrations (>10%) it is

corrosive. The critical pH for corrosivity is thought to be 12.5 [1, 7].

Ingestion of small volumes (up to 200 mL in adults; 50 mL in children) of sodium hypochlorite

solution (<10%) usually causes minimal health effects. In some cases it may cause burns to
the mouth, throat, oesophagus and stomach, pharyngeal pain and inflammation,
gastrointestinal irritation, nausea and vomiting [2, 3, 5, 8]. Dysphagia, stridor, drooling,
abdominal pain and dyspnoea may also occur [7, 9]. Severe irritation is uncommon unless
contact is prolonged or a large volume is ingested [2].

Ingestion of any amount of industrial strength bleach (>10% sodium hypochlorite) or large
amounts (approximately 300 mL in adults; 100 mL in children) of household bleach
(<10% sodium hypochlorite) may cause corrosive oesophagitis, haematemesis, abdominal
and retrosternal pain, diarrhoea and, in some cases, malaena and metabolic acidosis [3, 5,
8]. Symptoms other than vomiting do not strongly correlate with the amount of sodium
hypochlorite ingested [7]. In rare cases, the gastrointestinal mucosa may become
haemorrhagic, ulcerated and perforated, leading to shock [8].

Hypernatraemia, hyperchloraemia, hypotension and cardiovascular collapse may rarely

develop after ingestion of extremely large volumes of sodium hypochlorite (volumes not
stated) [5].

Aspiration of sodium hypochlorite or aspiration of contaminated vomit may occur. This

secondary source of pulmonary exposure may lead to ARDS [1-3].

Dermal/ocular exposure
Sodium hypochlorite itself is corrosive and may irritate the skin or cause burning pain,
inflammation and blisters. Skin damage may not be immediately apparent and may continue
to develop over time [3].

Ocular exposure to household bleach can cause mild irritation and temporary discomfort if
eyes are washed immediately [1]. Irritation becomes more severe and prolonged if eyes are
not washed. More concentrated solutions can cause pain, blepharospasm, lacrimation,
conjunctivitis, photophobia, necrosis and chemosis of the cornea, clouding of the cornea,
iritis, cataract formation and retinitis [3, 8].

Delayed effects following an acute exposure

Most children who ingest bleach swallow only small amounts and experience only vomiting
and gastrointestinal irritation. Pulmonary complications such as ARDS result from
aspiration [2]. A study of 19 children who ingested household bleach showed no short or
long-term sequalae [7, 10]. In contrast, severe respiratory sequelae were reported in a
toddler [10].

Potential sequelae following ingestion of sodium hypochlorite solution include bleeding,

perforation, scarring and stricture formation following corrosive injury to the mouth, throat,

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oesophagus and stomach, oesophageal obstruction, pyloric stenosis and vocal

cord paralysis [3].

Chlorine was used as a chemical warfare agent during World War I, hence it has been
widely documented. In follow-up studies of survivors there was no evidence of permanent
lung damage following inhalation of chlorine gas. Most studies indicated acute respiratory
disease but fewer chronic sequalae [4]. In contrast, more recent reports have suggested that
chronic sequalae following acute exposure may be more prevalent than previously thought,
such as toxic pneumonitis with respiratory compromise [4, 10].

There is some evidence to suggest that exposure to chlorine may also be associated with
long-term neuropsychological changes [11].

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Health Effects of Chronic/Repeated Exposure

Human data
Dermal/ocular exposure
Chronic dermal exposure to sodium hypochlorite solution may cause skin irritation [3]. Cases
of allergic contact dermatitis have been reported in the literature [12]. However, the cases
are isolated and often poorly reported, therefore sodium hypochlorite is not considered to be
a skin sensitisation hazard [13].

Carcinogenicity
No data was available from studies in humans on the carcinogenicity of hypochlorite salts
and there was inadequate evidence for the carcinogenicity of hypochlorite salts in
experimental animals. Overall, IARC assigned hypochlorite salts to group 3, ie compounds
that are not classifiable as to their carcinogenicity in humans [14].

Reproductive and developmental toxicity

There are no studies on the effect of direct exposure to sodium hypochlorite bleach in
pregnancy [15].

There is limited data on the effects of exposure to sodium hypochlorite in drinking water. This
data does not provide evidence of an increased risk of congenital malformations [15].
However, there is some evidence of other outcomes including an increased risk of pre-term
delivery, reduced fetal head circumference and decreased body length [15].

Animal and in-vitro data

Genotoxicity
Sodium hypochlorite has been shown to have some mutagenic activity in both bacterial and
mammalian cells in vitro [4]. Chromosomal aberrations were induced in Chinese hamster
ovary cells exposed to 0.5 mg/mL sodium hypochlorite in the presence of S9 mix, although it
was questioned whether such clastogenic effects were due to cytotoxicity. Chromosomal
aberrations were also demonstrated in Chinese hamster cells treated with 500 g/mL sodium
hypochlorite without metabolic activation [4]. Sodium hypochlorite was weakly genotoxic in
human leukocytes in vitro at concentrations similar to those used in disinfection processes,
as measured by the Comet assay, or at concentrations five- to ten-fold higher than those
used for water disinfection, measured by Saccharomyces cerevisiae strain D7 [16].

There is no evidence for activity in vivo [4]. Oral administration of chlorine at pH 8.5 (where
hypochlorite predominates) did not induce chromosomal aberrations or micronuclei in bone
marrow of CD-1 mice [17].

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Carcinogenicity
The carcinogenicity of sodium hypochlorite was investigated in rats treated with 500 or
1000 mg/L sodium hypochlorite for 104 weeks; no tumours were attributed to sodium
hypochlorite exposure [4]. Studies on female mice suggested that sodium hypochlorite could
act as a tumour promoter, although it largely depended on the initiator used [4].

Several in-vivo studies have been carried out to assess the carcinogenicity of sodium
hypochlorite. Male and female mice and rats were orally administered sodium hypochlorite
for 2 years; two strains of female mice had dermal application of sodium hypochlorite;
sodium hypochlorite was tested for its promoting effects in two strains of female mice
following initiation with 7,12-dimethylbenz[a]anthracene and 4-nitroquinoline 1-oxide,
respectively; male and female rats were administered sodium hypochlorite in drinking water
in a multigenerational study. All studies reported negative results. However, none of the
studies evaluated was considered adequate by IARC to draw definite conclusions [14].

Hypochlorite was classified in category 3 by IARC (not classifiable as to carcinogenicity in

humans); animal studies indicate that solutions of chlorine in water are not carcinogenic [14].

The US National Toxicology Program (NTP) investigated the carcinogenicity of chlorine

(up to 275 ppm) and chloramine (up to 200 ppm), dissolved in drinking water, in a 2-year
carcinogenicity bioassay in mice and rats. There was no evidence of carcinogenic activity of
chlorinated or chloraminated drinking water in male rats or male and female mice [18].

Reproductive and developmental toxicity

Sperm-head abnormalities in rats were increased (the significance of which is unknown)
following oral administration of 4 and 8 mg/kg of bw per day sodium hypochlorite prepared
from chlorine gas for 5 weeks [17]. However, no such effects were reported in another study
in male rats treated for 56 days prior to mating and no adverse effects in reproductive
outcome were observed in female rats treated 14 days prior to mating and through
gestation [4]. Furthermore, animal studies have demonstrated no reproductive or teratogenic
effect of chlorine exposure [4].

Various in-vivo studies have indicated no reproductive or developmental effects due to

exposure to chloramines [4].

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References
1. Racioppi F., et al., Household bleaches based on sodium hypochlorite: review of acute toxicology and
poison control centre experience. Food Chem. Toxicol., 1994. 32(9): p. 845-61.
2. International Programme on Chemical Safety (IPCS). Sodium hypochlorite. Poisons Information
Monograph. PIM 495, 1997, WHO: Geneva.
3. Agency for Toxic Substances and Disease Registry (ATSDR). Calcium Hypochlorite
(CaCL2O2)/Sodium Hypochlorite (NaOCl), in Medical Management Guidelines (MMG)2002, US
department of Health and Human Services: Atlanta, US.
4. International Programme on Chemical Safety (IPCS), Disinfectants and disinfectant by-products.
Environmental Health Criteria 216, 2000, WHO: Geneva.
5. MEDITEXT® Medical Management., Hypochlorites and related agents, in In: Klasco RK (Ed):
TOMES® System. Thomson Micromedex, Greenwood Village, Colorado (Edition expires [03, 2006]).
6. Gorguner M., et al., Reactive airways dysfunction syndrome in housewives due to a bleach-hydrochoric
acid mixture. Inhal. Toxicol., 2004. 16(2): p. 87-91.
7. Harley EH. and Collins MD., Liquid household bleach ingestion in children: a retrospective review.
Laryngoscope, 1997. 107(1): p. 122-5.
8. National Poisons Information Service (NPIS), Sodium hypochlorite. TOXBASE®. 2010 (As accessed
08/04/2014).
9. Einhorn A., et al., Serious respiratory consequences of detergent ingestions in children. Pediatrics.,
1989. 84(3): p. 472-4.
10. Babl FE., Kharsch S., and Woolf A., Airway edema following household bleach ingestion. Am. J.
Emerg. Med., 1998. 16: p. 514-516.
11. Dilks LS. and Matzenbacher DL., Residual neuropsychological sequelae of chlorine gas exposure.
Neurotoxicol Teratolol, 2003. 25: p. 391.
12. European Commission, SODIUM HYPOCHLORITE, in EU Risk Assessment Report, 2007:
Luxembourg.
13. Agency for Toxic Substances and Disease Registry (ATSDR), Toxicological Profile For Chlorine, 2010,
US department of Health and Human Services: Atlanta, US.
14. International Agency for the Research on Cancer (IARC), Chlorinated drinking water; chlorination by-
products; some other halogenated compounds; cobalt + cobalt compounds., 1991, IARC: Lyon.
15. UK National Teratology Information Service (UKTIS), Use of sodium hypochlorite (bleach) in
pregnancy, 2012.
16. Buschini A., et al., Sodium Hypochlorite-, chlorine dioxide- and peracetic acid-induced genotoxicity
detected by the Comet assay and Saccharomyces cerevisiae D7 tests. Mutagen., 2004. 19(2): p. 157-
162.
17. Meier JR., Bull RJ., and C.M. Stober JA., Evaluation of chemicals used in drinking water disinfection for
production of chromosomal damage and sperm-head abnormalities in mice. Environ. Mutagen., 1985.
7(2): p. 201-11.
18. National Toxicology Programme (NTP), Toxicology and Carcinogenesis Studies of Chlorinated Water
(CAS Nos. 7782-50-5 and 7681-52-9) and Chloraminated Water (CAS No. 10599-90-3) (Deionized and
Charcoal-Filtered) in F344/N Rats and B6C3F1 Mice (Drinking Water Studies). Technical Report 392
1992, Department of Health and Human Services.

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This document from the PHE Centre for Radiation, Chemical and Environmental Hazards
reflects understanding and evaluation of the current scientific evidence as presented and
referenced here.

First published: May 2015

For queries relating to this document, please contact: [email protected]

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