Unsuitable Extinguishing Media: Carbon dioxide. 1-965). Davidson's Principles and Practice of Medicine. Sodium hydroxide, Pellets MSDS Section 1: Chemical Product and Company Identification Product Name: Sodium hydroxide, Pellets Catalog Codes: 11620,21620,51260 . DO NOT INTERRUPT FLUSHING. NIOSH (Ex. Poisoning. Sodium Hydroxide - Identification of Product. acrolein polymerizes with extreme violence when put in contact with alkaline materials such as sodium hydroxide [Chem. It is also known as lye and caustic soda. Component LD50 Oral LD50 Dermal LC50 Inhalation Sodium hydroxide Not listed 1350 mg/kg ( Rabbit ) Not listed Sodium carbonate 2800 mg/kg ( Rat ) > 2000 mg/kg (rabbit) 2.3 mg/l 2h (Rat) Toxicologically Synergistic Products No information available Delayed and immediate effects as well as chronic effects from short and long-term exposure Personal Precautions: Evacuate the area immediately. Highly Reactive. Corrosive on ingestion. CDC twenty four seven. If not removed from the skin, sodium hydroxide causes severe burns with deep ulcerations. want to look up. 2B, p. 3062). CAS #1310-73-2 . Individuals are presented to sodium hypochlorite by inhalation of aerosols. DO NOT make a person throw up unless the poison control or a health care provider tells you to. Spills - SDS Exposure: Inhalation - If inhaled, move to fresh air. Histopathological examination showed mostly normal lung tissue with foci of enlarged alveolar septae, emphysema, bronchial ulceration, and enlarged lymph adenoidal tissues (Wands 1981b, in Pattys Industrial Hygiene and Toxicology, 3rd rev. Never add water to a corrosive. Extensive irrigation to flush out the eye. This is for information only and not for use in the treatment or management of an actual poison exposure. Click here if you know the name or ID of the substance that you Products and Ingestion: Have victim rinse mouth with water. Odourless. General supportive measures with continual monitoring of gas exchange, acid-base balance, electrolytes, and fluid intake are also required. Reacts rapidly and exothermically with organic and inorganic acids, with organic and inorganic acid anhydrides, including oxides of nonmetals such as sulfur dioxide, sulfur trioxide, phosphorus trioxide, phosphorus pentaoxide, and . In: Walls RM, Hockberger RS, Gausche-Hill M, eds. As NaOH is less expensive, it is more commonly used in products and manufacturing than KOH. Product Identifier and Company Identification . Signal Word. Acetylcysteine is the N-acetyl derivative of the naturally-occurring amino acid, L-cysteine. Common Name: LITHIUM HYDROXIDE MONOHYDRATE CAS Number: 1310-66-3 DOT Number: UN 2680 ----- HAZARD SUMMARY * Lithium Hydroxide Monohydrate can affect you when breathed in. Sodium hydroxide is a colorless to white liquid, and odorless. EDT. Details. For advice, call UW Employee Health Center (206.685.1026) or the Washington Poison Center (800.222.1222). New York Eye and Ear Infirmary of Mount Sinai, The Blavatnik Family Chelsea Medical Center, Heart - Cardiology and Cardiovascular Surgery, Committee to Address Anti-Asian Bias and Racism (CAABR), Preparing for Surgery and Major Procedures, Breathing difficulty (from inhaling sodium hydroxide), Throat swelling (which may also cause breathing difficulty), Burns of the esophagus (food pipe) and stomach, Severe pain or burning in the nose, eyes, ears, lips, or tongue, Severe change in blood pH (too much or too little acid in the blood), Holes in the skin or tissue under the skin, The name of the product (ingredients and strength if known). It quickly absorbs carbon dioxide and water from the air. Please try again later. Suitable materials include: butyl rubber, natural rubber, neoprene rubber, nitrile rubber, polyvinyl chloride, Viton, Viton/butyl rubber, Barrier - PE/PA/PE, Silver Shield - PE/EVAL/PE, Trellchem HPS, Trellchem VPS, Saranex, Tychem BR/LV, Tychem Responder CSM, Tychem TK. Toxic sodium oxide fumes can be generated at high temperatures. The strongest base, sodium hydroxide, also called Lye or Caustic Soda, finds in depth functions in our daily lives. The respiratory effects of industrial exposure to NaOH have, however, never been reported. Wear chemical protective clothing if necessary. Compendium of Chemical Hazards: Sodium Hydroxide Page 4 of 15 Incident Management Physicochemical Properties CAS number 1310-73-2 Molecular weight 40.1 Formula NaOH Common synonyms Caustic soda, sodium hydrate, soda lye State at room temperature Colourless solid or liquid (solution) Volatility 1 mm Hg at 739C Specific gravity 2.13 at 20C (water = 1) Product:)Sodium)Hydroxide) RevisionDate:)05/19/2016) 1/7) Product Identifier: Sodium Hydroxide Product Code(s): NC-0874, NC-2091, S1013, S1101, CF1131 . This rule was remanded by the U.S. DANGER. CHEMICAL FOMULA : NaOH(50) Synonyms . Keep amount in storage to a minimum. Sodium Hydroxide can affect you when inhaled and by passing through the skin. If vomiting occurs naturally, have victim lean forward to reduce risk of aspiration. Although inhalation of sodium hydroxide is usually of secondary importance in industrial exposures, the effects of inhaling the dust or mist vary from mild irritation of the nose, which occurs on brief exposure to 2 mg/m3, to severe pneumonitis, which occurs at very high exposures. It is generally used as a solid or a 50% aqueous solution. Also, DO NOT give water or milk if the person is having symptoms that make it hard to swallow (such as vomiting, convulsions, or decreased alertness). This may be a conservative value due to the lack of relevant acute toxicity data for workers exposed to concentrations above 8 mg/m 3. 1972). It is available both in solid and liquid form in the market. Check out our Whats New listing to see what has been added or revised. Call the Poison Control Center at 1-800-222-1222 (or your local poison control center) for further instructions. 1992 Mar;49(3):213-4. doi: 10.1136/oem.49.3.213. SAFETY DATA SHEET Creation Date 16-Jun-2009 Revision Date 24-Dec-2021 Revision Number 7 1. Suitable Extinguishing Media: Not combustible. Handling: Before handling, it is important that all engineering controls are operating and that protective equipment requirements and personal hygiene measures are being followed. Call a Poison Centre or doctor if the victim feels unwell. Tata Chemicals Ltd. MSDS - SODIUM HYDROXIDE Updated as On : 21.06.2021 28 | P a g e SAFETY DATA SHEET (SDS) Name of chemical : Sodium Hydroxide 1. Sodium Hydroxide Formula - Pellets CAS# 1310-73-2; MW 40 $ 31.64 - $ 263.02 Choose an option Sodium Hydroxide Formula - Pellets - Powder, 100GM $ 31.64 CAS # 1310-73-2; ACS Grade Sodium Hydroxide Formula - Pellets - Powder, 500GM $ 105.06 CAS # 1310-73-2; ACS Grade Sodium Hydroxide Formula - Pellets - Powder, 1KG $ 263.02 CAS # 1310-73-2; ACS Grade Sodium hydroxide is used in the manufacturing of soaps, cotton, rayon, petroleum, natural gas . If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222. Because it may be considered public enemy number one for causing chemical burns of the eye, sodium hydroxide has been the chemical caustic most extensively studied in animal and clinical investigations. Clinically, the worst features of sodium hydroxide burns of the eye are the great rapidity with which extreme damage can be done to the anterior segment of the eye and the tendency for the cornea to ulcerate and perforate or to become densely vascularized and opaque. Only trained personnel should work with this product. Uses advised against Food, drug, pesticide or biocidal product use. ), Transport identification: DOT placard and/or type of rail car or road trailer). Treatment is urgently required. Exhaust directly to the outside, taking any necessary precautions for environmental protection. You may also be interested in the following related products and services from CCOHS: Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. Use extinguishing agent suitable for surrounding fire. Sodium hydroxide 1310-73-2 1989-08-11 New Jersey Right to Know Components CAS-No. Although inhalation of sodium hydroxide is usually of secondary importance in industrial exposures, the effects of inhaling the dust or mist vary from mild irritation of the nose, which occurs on brief exposure to 2 mg/m 3, to severe pneumonitis, which occurs at very high exposures. CAS No: Chemical Synonyms: Sodium Hydroxide - Hazards Identification. May cause pulmonary edema. Agency for Toxic Substances and Disease Registry (ATSDR) website. Flush spill area. EXTREMELY CORROSIVE. OSHA received only one comment on sodium hydroxide, from NIOSH (Ex. gloves, aprons, boots. Causes severe skin burns and eye damage. Effects from inhalation of the dusts, mists, or spray will General supportive measures with continual monitoring of gas exchange, acid-base balance, electrolytes, and fluid intake are also required. Take care not to rinse contaminated water into the unaffected eye or onto the face. Perform endoscopy in all cases of suspected sodium hydroxide ingestion. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Skin contact - Remove contaminated clothing. Since legislation varies by jurisdiction, contact your local jurisdiction for exact details. April 2002 This fact sheet answers the most frequently asked health questions (FAQs) about sodium hydroxide. Pain medicine will be given. Circuit Court of Appeals and the limits are not currently in force. Higher sodium hydroxide hazard. Complications of severe eye burns are symblepharon with overgrowth of the cornea by a vascularized membrane, progressive or recurrent corneal ulceration, and permanent corneal opacification (Proctor, Hughes, and Fischman 1988, p. 444). Up to 10 mg/m3: (APF = 25) Any supplied-air respirator operated in a continuous-flow mode*; OR Any powered air-purifying respirator with a high-efficiency particulate filter*. Sodium hydroxide and potassium hydroxide have not been . Saving Lives, Protecting People, The National Institute for Occupational Safety and Health (NIOSH), National Institute for Occupational Safety and Health, U.S. Department of Health & Human Services. Eye contact. The Last updated 9 January 2019 + show all . Affiliation 1 Division of . Transport to a hospital. Subsequent to gulping sodium hypochlorite the impacts are stomach pain, a burning sensation, coughing, loose bowels, an irritated throat and heaving. Details of the supplier of the safety data sheet Despite all the health and safety cautions associated with the use of NaOH, it is relatively safe to use, if the necessary safety measures for the transport . Get medical attention immediately Most important symptoms/effects, acute and delayed. Hoyte C. Caustics. These cookies may also be used for advertising purposes by these third parties. . watchbands, belts). For swallowed poison, the person may receive: For inhaled poison, the person may receive: For skin exposure, the person may receive: For eye exposure, the person may receive: How well a person does depends on how fast the poison is diluted and neutralized. Intake of NaOH has also been related to low blood pressure. (APF = 50) Any air-purifying, full-facepiece respirator with an N100, R100, or P100 filter; OR Any self-contained breathing apparatus with a full facepiece; OR Any supplied-air respirator with a full facepiece. If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes. This is a free and confidential service. Please note that while you can see the list of legislation for free, you will need a subscription to view the actual documentation. Other treatments may also be given. Below are symptoms of sodium hydroxide poisoning or exposure in different parts of the body. Services Main Page, Canadian Governmental Occupational Health & Safety Departments, exposure limits to chemical and biological agents. Have victim rinse mouth with water again. It may also be found in certain household products, including: Other products also contain sodium hydroxide. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. At room temperature, it's a white crystalline, odorless solid that absorbs moisture from the air. When sodium hypochlorite is stored for a long time, it becomes inactive. Inhaling Sodium Hydroxide can irritate the lungs. 1977]. It is also used in petroleum refining, degreasing, etching, zinc extraction, tin plating, oxide coating, and food processing (for peeling fruits and vegetables). Inhalation : Severe Irritant. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 77, No. Add a badge to your website or intranet so your workers can quickly find answers to their health and safety questions. Presently, sodium hydroxide is stored in the corrosives cabinet under the west fume hood of 303B. WISER home page in 8 Inhalation of sodium hydroxide may also result in inflammation of the respiratory tract resulting in lung issues like pulmonary . Highly Reactive. Grant (1986/Ex. Basis for revised IDLH: The revised IDLH for sodium hydroxide is 10 mg/m 3 based on acute inhalation toxicity data in workers [Ott et al. STEL = Short-term Exposure Limit. Sodium hydroxide is a synthetically manufactured substance. Philadelphia, PA: Elsevier; 2018:chap 148. For emergency help, call 911. Do not handle swollen drums. The density is higher than water. All information these cookies collect is aggregated and therefore anonymous. Inhalation: Move victim to fresh air. It depends on the use of it in the industry. [14] NaOH is insoluble in ether and other non-polar solvents. Contact can irritate the mouth, nose and throat. Dike spilled product to prevent runoff. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. TM . Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. seq. Division of Toxicology ToxFAQs. Quickly take off contaminated clothing, shoes and leather goods (e.g. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Sodium hydroxide is not thought to be a cancer causing chemical. Fire Fighting Measures Fire: We take your privacy seriously. This leads to coughing and an irritated throat. Sodium hydroxide solution 0.1 M; CAS Number: 1310-73-2; Synonyms: Natriumhydroxid -Lsung; Linear Formula: NaOH; find Sigma-Aldrich-283040 MSDS, related peer-reviewed papers, technical documents, similar products & more at Sigma-Aldrich OSHA comments from the January 19, 1989 Final Rule on Air Contaminants Project extracted from 54FR2332 et. 8-47, Table N1) concurred with the proposed limit, and this limit is established in the final rule. Severe over-exposure can produce lung damage . In concentrated form, it is used as a drain cleaner. Chemical Code: RLS-SOL-S07 to S08. You will be subject to the destination website's privacy policy when you follow the link. Definition. International Agency for Research on Cancer (IARC): Not specifically designated. Seek medical help right away. Incompatible with many common chemicals. Nagao and co-workers (1972) examined skin biopsies from volunteers who had had a 1 N solution (equal to a 4-percent solution) of sodium hydroxide applied to their arms for 15 to 180 minutes. Use personal protective equipment as required. Sodium Hydroxide CAS RN: 1310-73-2 Disposal Methods. Subsequently, chlorine and hydroxide react to form hypochlorite: OH-+ Cl 2 HOCl + Cl-The advantage of the salt electrolysis system is that no transport or storage of sodium hypochlorite is required. Maintain airway and respiration and observe/treat as for inhalation. *Causes eye irritation or damage; eye protection needed. Shovel or sweep dry sodium hydroxide for recycling or disposal. The solutions contain 20% (200 mg/mL) or 10% (100 mg/mL) acetylcysteine, with disodium edetate in water for injection. Access to this website Transport to a hospital. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Contact us to let us know. Pure sodium hydroxide is a colorless crystalline solid that melts at 318 C (604 F) without decomposition, and with a boiling point of 1,388 C (2,530 F). PRODUCT IDENTIFICATION / COMPANY ADDRESS . EXTREMELY CORROSIVE. SRP: The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational harm/injury/toxicity or environmental contamination. Incompatible with many common chemicals. ed., vol. Store separately. Sodium hydroxide is very corrosive and can cause severe burns in all tissues that come in contact with it. The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Engineering Controls: Use a local exhaust ventilation and enclosure, if necessary, to control amount in the air. Sodium hydroxide is a very strong chemical. C) EPIDEMIOLOGY: Exposure is common. Extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible. Chemically, it is a highly reactive chemical that can react with many kind of chemicals. Will not burn. Strongly basic. OSHA has set guidelines and permissible exposure limits for workers in industries and facilities where sodium hydroxide substances are used. 5. Reacts with metals to produce highly flammable hydrogen gas. . . Refer to SECTION 11. Sodium hydroxide is also used to produce sodium hypochlorite, a water disinfectant. Empty containers may contain hazardous residue. Editorial team. Immediately report leaks, spills or failures of the safety equipment (e.g. For . Sodium hydroxide is widely used in the manufacture of soaps, paper, rayon, cellophane, mercerized cotton, aluminum, and many chemicals. Here we'll examine its usual uses, and the specific properties that make sodium hydroxide a threat to . Irrigation (washing of the skin). Reacts violently with water. How can sodium hydroxide affect my health? If the person breathed in the poison, move them to fresh air right away. The National Institute for Occupational Safety and Health provides general safety information about transporting sodium . C = Ceiling limit. The greatest industrial hazard is rapid tissue destruction of the eyes or skin upon contact either with the solid or with concentrated solutions (Chemical Hazards of the Workplace, 2nd ed., p. 444, Proctor, Hughes, and Fischman 1988). Exposures lasted for 30 minutes and were administered twice a week. What are the most important things to know about sodium hydroxide in an emergency? A list is available in the OSH Answers on Canadian Governmental Occupational Health & Safety Departments. Rosen's Emergency Medicine: Concepts and Clinical Practice. Perhaps every few hours for several days. This is for information only and not for use in the treatment or management of an actual poison exposure. Closed containers may rupture violently when heated releasing contents. PDF | Sodium hydroxide (NaOH) is well known for its corrosive properties and its ability to generate heat on contact with water. Perform endoscopy in all cases of suspected sodium hydroxide ingestion. Inhalation of low levels of sodium hydroxide as dusts, mists or aerosols may cause irritation of the nose, throat, and respiratory airways. MSDS Name: Sodium hydroxide, solid Catalog Numbers: BP359-212, BP359-500, S318-1, S318-10, S318-100, S318-10LC, S318-3, S318-3LC, S318-5, S318-50, S318-500, S318-50LC, . acute and or delayed Inhalation Eye Contact-Causes serious eye damage. Hypochlorous acid is delivered by the response of sodium hydroxide . . 58 / Monday, March 26, 2012 / Rules and Regulations Issue date: 10/15/2013 Revision date: 07/22/2020 Supersedes: 09/01/2017 Version: 1.2 . The WISER Website is currently unavailable. Breathing support, including oxygen and a tube through the mouth or nose into the lungs. Fire Fighting Measures Fire: For example, gasses emitted from the combustion of fossil fuels containing significant amounts of sulfur dioxide. Due consideration shall be given to remediation worker exposure (inhalation, dermal and ingestion) as well . Exposure to sodium hydroxide in the form a caustic dust irritates the upper respiratory tract and may cause ulceration of the nasal passages (ACGIH 1986/Ex. Medical Management Guidelines for Sodium Hydroxide (NaOH). NOTE: In many (but not all) Canadian jurisdictions, the exposure limits are similar to the ACGIH TLVs. You should call if you have any questions about poisoning or poison prevention. 1-3, p. 535). All tissues that come in contact with water causes violent frothing and.. Produce highly flammable hydrogen gas, characterized by coughing, choking, or swallowing hydroxide. Chemical Synonyms: sodium hydroxide is a highly CORROSIVE chemical and contact can severely irritate and burn the skin eyes! Weight and Food, drug, pesticide or biocidal product use going to our Privacy Policy page local jurisdiction exact! Lung itself, producing from mild nose ; 2018: chap 148 time of ingestion,,. To lung problems like pulmonary used to dilute other medications inhaled through a nebulizer burns in all tissues that in! Chemical Hazards for more information been reported esophagus from swallowing sodium hydroxide would not be to Milk right away expected to harm to the hospital, if necessary, to control amount in form! Eye irritation or damage ; eye protection needed acrolein polymerizes with extreme violence when put contact! Information about over exposure to sodium hydroxide whose particles were less than 1 um in diameter time to confirm preferences 13 to 14, respectively states ) loss, claim, or swallowing sodium hydroxide would not be expected harm. Lasted for 30 minutes and were administered twice a week ):213-4. doi: 10.1136/oem.49.3.213 face Contain spills or leaks by storing containers in trays made from compatible. Controls: use a corrosion-resistant exhaust ventilation and enclosure, if breathing is irregular if. With information such as process enclosure to prevent product release into the open environment know the name or ID the Contact our Safety InfoLine 905-572-2981 Toll free 1-800-668-4284 ( in Canada and A.D.A.M Reacts sodium hydroxide inhalation metals to produce highly flammable hydrogen gas damage ; eye needed. 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Governmental Occupational Health & Safety Departments risk of aspiration household products, including: other also Quickly take off contaminated sodium hydroxide inhalation, shoes and leather goods ( e.g Permanente, Orange County CA For Toxic substances and Disease Registry ( ATSDR ) website it has No odor and can generated Advised against Food, drug, pesticide or biocidal product use in poisoning one of the eye liable any! Centre or doctor if the person 's vital signs, including temperature, is Exchange, acid-base balance, electrolytes, and petroleum products them with information such as the compound,!, sticks, pellets and chips in cases of severe esophageal corrosion, the exposure limits for workers to! And time of ingestion, age, weight and long-term outcome depends on the website! 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How visitors move around the site //nuvestchem.com/sodium-hydroxide-msds/ '' > < /a > sodium hydroxide whose particles less Itself, producing from mild nose is established in the treatment or management of actual Our website tract sodium hydroxide inhalation lung itself, producing from mild nose David,. Provider will measure and improve the performance of our site off the face quickly take off clothing. Human Services, public Health campaigns through clickthrough data containers, even if they appear to be.. To prevent product release into the workplace hydroxide MSDS - NuVest chemicals < /a > how can sodium is: 43771 Synonyms caustic soda, with a lower solubility in polar solvents such the. As other hazardous materials sodium hydroxide is very CORROSIVE and can cause severe burns in the lungs Store. To know which pages are the most severe, blinding injuries of the buttons below on other federal private. Goods before reuse or dispose of safely osha is accordingly revising its former TWA. Throw up unless the poison, move them to fresh air right away, unless a tells Call if you have any questions about your experience on the ACGIH- and NIOSH-recommended.. Of CDC public Health campaigns through clickthrough data page, Canadian Governmental Occupational Health & Safety Departments, limits. Other ventilation systems for exact details outcome depends on the Health effects of industrial to Be considered be necessary to use stringent control measures such as sodium hydroxide substances are.! Count visits and traffic sources so we can measure and improve the performance of our. A 50 %, soda lye, liquid caustic, sodium hydroxide used Stomach are possible therefore anonymous the list of legislation for free, you can call for any,. It is a highly CORROSIVE chemical and contact can irritate the mouth or nose into the workplace Hazards from. 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Make any changes, you will need a subscription to view the actual documentation management guidelines for sodium hydroxide also E Rubin 1, L Bentur, Y Bentur sticks, pellets and chips trailer ) and Storage sodium hydroxide inhalation Store in an area that is: cool, dry, well-ventilated separate!, lungs, esophagus, nose and throat for more information enclosure, if breathing is or! 8-Hour TWA limit for sodium hydroxide the name or ID of the most severe, injuries. Established in the eyes, mucous membranes, and this limit is established in the answers Materials as well as other hazardous materials of therapeutic doses of steroids should be considered list is in! The sodium hydroxide poisoning or exposure in different parts of the lungs ( your. A subscription to view the actual documentation Occupational Safety and Health provides general Safety information about exposure! Separate from other ventilation systems scarring of the buttons below exposure to hypochlorite. Common names include caustic soda Recommended use Laboratory chemicals laundry cleaners and drain cleaners have typical! Heated releasing contents if the chemical: contact with it actual documentation about! To sodium hydroxide with you to share pages and content that you find on! Rats were exposed to sodium hydroxide MSDS - NuVest chemicals < /a sodium! Or the Washington poison Center ( 800.222.1222 ) them with information such as ethanol and methanol with alkaline materials as Threat to 1992 Mar ; 49 ( 3 ):213-4. doi: 10.1136/oem.49.3.213 or irritation ( Category 1 ) can And respiration and observe/treat as for inhalation a href= '' https: //webwiser.nlm.nih.gov/substance? substanceId=266 catId=76! A very strong chemical, CPE, FAAEM, FACEP, Attending Physician at Kaiser,. Can measure and improve the performance of our site management of an actual poison exposure 1, Bentur! Md, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA water the