National Patient Safety Alert: Inadvertent oral administration of potassium permanganate

A joint National Patient Safety Alert has been issued by the NHS England and NHS Improvement National Patient Safety Team, and the British Association of Dermatologists, on the risk of inadvertent oral administration of potassium permanganate (i.e.  the accidental administration of potassium permanganate by mouth).

 

WHAT IS POTASSIUM PERMANGANATE USED FOR?

Potassium permanganate is for external use and can be used to treat weeping and blistering skin conditions, such as acute weeping/ infected eczema and leg ulcers.

 

WHAT SAFETY RISK HAS BEEN IDENTIFIED?

Potassium permanganate is supplied in concentrated forms, either as a ‘tablet’ or a solution that need to be diluted with water before it is used as a soak or in the bath. The risk is that these concentrated forms resemble an oral tablet or juice drink and might be swallowed by mistake.

Potassium permanganate is highly toxic if swallowed and can cause:

• rapid swelling and bleeding of the lips and tongue,
• gross oropharyngeal oedema (swelling of the throat),
• local tissue necrosis (death of body tissue),
• stridor (noisy breathing),
• gastrointestinal ulceration.

Swallowing potassium permanganate can be fatal due to:

• gastrointestinal bleeding,
• acute respiratory distress syndrome, where fluid accumulates in the lungs and they become unable to supply the vital organs with enough oxygen,
• multiorgan failure, where more than one vital organ, such as the lungs, heart or liver stop functioning.

 

Important - Even dilute solutions can be toxic if swallowed.

 

ACTIONS REQUIRED

The alert asks both secondary and primary care providers to take action to assess if the benefit of using potassium permanganate outweighs the risk. And, if use is to continue, ensure:

• Safer prescribing and labelling
• It is stored safely, clearly separated from internal medicines.