Background

Hydrocarbons are a heterogenous group of organic substances that are quite abundant in modern society.
Some of the most commonly ingested hydrocarbons include gasoline, motor oil, and kerosene.; most are liquid.
Proportionately, more fatalities are associated with children younger than 5 years who often accidentally ingest
hydrocarbons, Typically, children do not drink large quantities, as hydrocarbons generally taste bad.
PATHOPHY
Toxicity from hydrocarbon ingestion can affect many different organs, but the lungs are the most commonly
affected organ. The chemical properties of the individual hydrocarbon determine the specific toxicity, while the
dose and route of ingestion affect which organs are exposed to the toxicity. The viscosity is the single most
important chemical property associated with the aspiration risk. [2]

History
In cases of suspected hydrocarbon intoxication, it is important to determine the agent ingested, the route of
ingestion (eg, oral, dermal, inhalational) the amount of substance ingested, and the time of the ingestion. In
addition, the history should include questions about co-ingestants, any vomiting or coughing prior to arrival, and
any attempt to treat the patient prior to arrival.

SYMPTOMS
The lung is the primary site of most common toxicity following hydrocarbon exposures. Pulmonary toxicity most
often occurs following ingestion and subsequent aspiration of hydrocarbon.
Respiratory symptoms (eg, coughing, gagging, choking) usually occur within 30 minutes of exposure but often
can be delayed several hours.
Many patients develop a transient cough. A prolonged cough and hypoxia, however, is more concerning for
aspiration.
The most common CNS symptoms include headache, lethargy, and decreased mental status. Nonspecific
symptoms such as weakness and fatigue may also be reported.
The patient may complain of dyspnea or syncope.
Nausea, vomiting, and sore throat are frequent but are relatively mild.
Local reactions such as a burning sensation in the mouth, pruritus, or a perioral rash are not uncommon and
are usually mild.
Diarrhea, melena, and hematemesis are rare.
Prior to instituting the physical examination, the patient should be appropriately decontaminated, if indicated.
The physical examination should focus on the patient's airway, breathing, and circulation (ABCs).
Patients who are experiencing any respiratory compromise should be placed on supplemental oxygen. For
those patients who are in severe respiratory distress, or who are too lethargic to be able to adequately protect
their airway, advanced airway management may be required.

Respiratory

Coughing
Gagging
Choking
Tachypnea
Hemoptysis
Rales
Rhonchi
Wheezes
Hypoxia
Cyanosis

Cardiovascular
See the list below:

Tachycardia
Dysrhythmias
Hypotension

CNS
See the list below:

Headache
Ataxia
Weakness
Lethargy to coma
Seizures
GI - Nausea/vomiting

Dermal

Erythema
Blistering
Pain
Nasal dermatitis or perioral dermatitis (with chronic abuse)
Skin irritation (with single use) at an intravenous, intramuscular, or subcutaneous injection site

Causes
Hydrocarbon exposure can be divided into the following 4 broad categories:

Nonintentional nonoccupational exposure: Accidental ingestions are the most frequent type and
commonly involve young children tasting a hydrocarbon. Typically, children do not drink large quantities, as
hydrocarbons generally taste bad. Adults and older children occasionally consume a hydrocarbon if liquid is
placed in an unlabeled can or bottle resulting in accidental ingestion.
Recreational exposure: Inhaling of hydrocarbons or other volatile solvents for the purpose of producing
a transient state of euphoria is becoming more common. This pattern of use is most common in junior high
and high-school aged children.

Occupational exposure: This type of exposure is most often industrial, where a worker has either a
dermal exposure to the liquid or an inhalational exposure to the vapors.
Intentional: This type of exposure usually involves consuming a large amount of the hydrocarbon as an
oral ingestion during a suicide attempt.

Diagnostic Considerations
Other problems to be considered in the differential diagnosis include the following:

Inhalation injury
Carbon monoxide poisoning
Aspiration
Suicidality
Co-ingestions

Prehospital Care
See the list below:

Prehospital care should focus on decontamination, followed by immediate transport to a medical

facility capable of managing such a patient.
Decontamination should focus on removing any remaining hydrocarbon that might be on the clothes or
skin, in the correct clinical setting.
All patients should have their airway, breathing, and circulation managed per routine advanced life
support protocols
Patients should be kept calm to prevent arrhythmia as a result of myocardial sensitization.
.
Symptomatic patients should receive intravenous access and cardiac monitoring.

Emergency Department Care

Management for hydrocarbon intoxication is largely supportive.
Decontamination of the GI tract remains controversial.
The use of ipecac-induced emesis is contraindicated, and activated charcoal does not absorb hydrocarbons
well.
Gastric lavage should not be routinely performed.

Medical Care
Antibiotics are frequently given to patients who develop a pneumonitis following hydrocarbon aspiration. In
animal models, the empiric administration of antibiotics altered the lung flora compared with controls and did
not yield any benefit. Clinically, superinfection can definitely occur. Because the pneumonitis itself can create
abnormal lung sounds, fever, and leukocytosis, distinguishing if these effects are because of a superimposed
infection or if they are the result of the pneumonitis itself is often difficult. Any finding on a chest radiograph
within a few hours of the exposure, however, is unlikely to be pneumonia, and much more likely to be a
pneumonitis.
Steroids have not been proven to be beneficial.
Several commercial surfactant preparations are available for use with other conditions, such as hyaline
membrane disease (HMD). Animal data on its use demonstrate conflicting results, and currently no human data
exist to support its routine use.

Stabilization of the airway is always the first priority of treatment in patients with hydrocarbon
poisoning. Give supplemental oxygen to all patients, and perform bedside pulse oximetry. Early
intubation, mechanical ventilation, and use of positive end-expiratory pressure may be warranted in a
patient with inadequate oxygenation, severe respiratory distress, or a decreased level of
consciousness. Take all precautions to minimize the patient's risk of vomiting and further aspiration. A
trial of bronchodilators may prove useful in patients with suspected bronchospasm.
Before gastric decontamination is performed, the airway must be stabilized to minimize the risk of aspiration if
the patient vomits. Because aspiration is a major complication of hydrocarbon ingestion, reserve gastric
decontamination for patients with large intentional ingestions or those at increased risk of systemic toxicity.
Activated charcoal has a limited role in the management of hydrocarbon ingestion. Charcoal poorly adsorbs
most hydrocarbons. Furthermore, charcoal tends to distend the stomach and cause vomiting, increasing the
aspiration potential.

Medication Summary
No specific antidotes are available for hydrocarbon poisoning. Treatment with prophylactic antibiotics is not
beneficial.[11] Corticosteroid therapy is also not beneficial, and may be harmful in some cases.