Chapter 11: Management of Hydrocarbon Poisoning

Introduction

Hydrocarbons are used in a wide variety of industrial processes. Examples of these organic compoiunds
include gasoline, kerosene, lubricating oil, motor oil, mineral spirits, naphtha. Hydrocarbons may also be
found as part of dry cleaning solutions, paint thinners, furniture polish, turpentine and other solvents..
Some of these, especially organic solvents containing toluene, are abused by inhalation with much
resulting euphoria for the abusers. A useful mnemonic for remembering such hydrocarbons is CHAMP:
camphor, halogenated hydrocarbons, aromatic hydrocarbons, (heavy) metal-containing hydrocarbons,
and pesticide-containing hydrocarbons. Most of the dangerous hydrocarbons are derived from
petroleum distillates and include aliphatic hydrocarbons and aromatic hydrocarbons. Other
hydrocarbons such as pine oil and turpentine are derived from wood.

Types of exposure include unintentional ingestion, intentional recreational abuse, unintentional

inhalation, and dermal exposure or oral ingestion in a suicide attempt. The highest rates of morbidity
and mortality result from accidental ingestion by children younger than 5 years. Aspiration pneumonitis
is the common complication of hydrocarbon ingestion, followed by CNS and cardiovascular effects.

Pathophysiology

The toxic potential of hydrocarbons is directly related to their physical properties. Highly volatile
compounds with low viscosity are more likely to be inhaled or aspirated into the respiratory system.

Pulmonary effects

Pulmonary toxicity is the result of hydrocarbon aspiration. The result is often inflammation and
bronchospasm. The volatile chemical may displace alveolar oxygen, leading to hypoxia. Direct toxic
effects on the alveoli result in poor oxygen exchange, atelectasis, and pneumonitis. Respiratory
symptoms generally begin in the first few hours after exposure and usually resolve in 2-8 days.
Complications include hypoxia, barotrauma due to mechanical ventilation, and acute respiratory distress
syndrome (ARDS). Prolonged hypoxia may result in encephalopathy, seizures, and death.

Gastrointestinal effects

Hydrocarbons cause irritation with abdominal pain, nausea and vomiting with possibility of aspiration.

CNS effects

This includes behavioural disinhibition similar to that seen in patients with alcohol intoxication. Narcosis
and euphoria may also develop. Lethargy, headache, obtundation, and coma may follow. Seizures are
uncommon and are likely to be due to hypoxia.

Cardiac effects
Dysrhythmias occur owing to hypoxia, myocardial sensitization to catecholamines, and direct myocardial
damage. Sudden death rarely occurs from coronary vasospasm due to hydrocarbon inhalation.

Other effects

Bone marrow toxicity, hemolysis, liver and kidney failure have all been reported. Toluene, a major
constituent of organic solvents, may cause renal tubular acidosis, local skin irritation and chemical burns.
Most deaths from hydrocarbons occur in children younger than 5 years. Long-term exposure may result
in cardiomyopathy, cerebellar atrophy, dementia, cognitive deficits, and peripheral neuropathy.

Physical findings

Hydrocarbon aspiration can elevate body temperature. Other findings at physical examination include:

• Respiratory: Coughing, Choking, Fever, Tachypnea, Grunting, Cyanosis, Rales, and Wheezing.

• CNS: Headache, Dizziness, Lethargy, Ataxia, Seizures, Coma

• GI: Nausea, Vomiting, Abdominal pain

• Cardiac: Arrhythmia

• Skin: Mucosal irritation, Chemical burns

Medical Care

ABCs: Maintain an open airway. Give supplemental oxygen to all patients, and perform beside pulse
oximetry. Early intubation, mechanical ventilation, and use of positive end-expiratory pressure may be
warranted in patients in whom oxygenation is inadequate or in those with severe respiratory distress or
decreased level of consciousness. Precautions to minimize the patient's risk of vomiting and further
aspiration are important. In the presence of wheezing, a trial of bronchodilators may be warranted.

Skin decontamination, if cutaneous exposure, must be carried out as soon as possible by removing
clothing and thoroughly washing the skin with soap and water. Vapor inhalation and cutaneous
absorption may occur long after the exposure.

If gastric decontamination is considered, the airway must be secured to minimize risk of aspiration
secondary to vomiting. Gastric decontamination is reserved only for large intentional ingestions. No
specific antidotes are available for hydrocarbon poisoning. Treatment with corticosteroids and
prophylactic antibiotics is not beneficial. In some cases, steroids may be harmful