eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Hydrocarbons: Differential Diagnoses & Workup

Author: Randy J Goldstein, MD, Emergency Department Medical Director, Las Palmas Medical Center
Contributor Information and Disclosures

Updated: Dec 9, 2008

Differential Diagnoses

Atelectasis, Pulmonary
Inhalation Injury
Near Drowning
Pneumonia
Respiratory Distress Syndrome

Workup

Laboratory Studies

  • ABG assessment
    • ABG analysis is useful in documenting hypoxemia in severely affected patients.
    • Hypercarbia may be observed in patients with respiratory depression and decreased gas exchange.
  • Serum chemical tests
    • In the acute phase, serum chemical results are expected to be within the normal ranges.
    • An increased anion gap may indicate co-ingestion of another toxin.

Imaging Studies

  • Chest radiography
    • A chest radiograph must be obtained in all symptomatic patients.
    • Initially, the chest radiographic results may be normal, but positive findings may develop over the first few hours after ingestion.
  • Common findings include fine perihilar opacities, bibasilar infiltrates, and atelectasis.
    • Obtain repeat radiographs if any acute change in the patient's respiratory status occurs because a pneumothorax or pneumomediastinum may develop.
    • If discharge is being considered for an asymptomatic patient, a chest radiograph should be obtained 6 hours after the ingestion to document the negative findings.

Other Tests

  • Bedside pulse oximetry is useful in the emergency department because hypoxia is a direct result of hydrocarbon aspiration.
  • Obtain an ECG if cardiac arrhythmia is a concern.

More on Toxicity, Hydrocarbons

Overview: Toxicity, Hydrocarbons
Differential Diagnoses & Workup: Toxicity, Hydrocarbons
Treatment & Medication: Toxicity, Hydrocarbons
Follow-up: Toxicity, Hydrocarbons
Multimedia: Toxicity, Hydrocarbons
References
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References

  1. Siddiqui EU, Razzak JA, Naz F, Khan SJ. Factors associated with hydrocarbon ingestion in children. J Pak Med Assoc. Nov 2008;58(11):608-12. [Medline].

  2. Anas N, Namasonthi V, Ginsburg CM. Criteria for hospitalizing children who have ingested products containing hydrocarbons. JAMA. Aug 21 1981;246(8):840-3. [Medline].

  3. Arena JM. Hydrocarbon poisoning--current management. Pediatr Ann. Nov 1987;16(11):879-83. [Medline].

  4. Colucciello SA, Tomaszewski C. Substance abuse. In: Emergency Medicine, Concepts and Clinical Practice. 4th ed. 1998:2879-901.

  5. Dice WH, Ward G, Kelley J, Kilpatrick WR. Pulmonary toxicity following gastrointestinal ingestion of kerosene. Ann Emerg Med. Mar 1982;11(3):138-42. [Medline].

  6. Eade NR, Taussig LM, Marks MI. Hydrocarbon pneumonitis. Pediatrics. Sep 1974;54(3):351-7. [Medline].

  7. Klein BL, Simon JE. Hydrocarbon poisonings. Pediatr Clin North Am. Apr 1986;33(2):411-9. [Medline].

  8. Lee DC. Hydrocarbons. In: Emergency Medicine, Concepts and Clinical Practice. 4th ed. 1998:1362-6.

  9. Ramon MF, Ballesteros S, Martinez-Arrieta R, et al. Volatile substance and other drug abuse inhalation in Spain. J Toxicol Clin Toxicol. 2003;41(7):931-6. [Medline].

  10. Scalzo AJ. Inhalation injuries. In: Pediatric Emergency Medicine, Concepts and Clinical Practice. 2nd ed. 1997:590-3.

  11. Shis RD. Hydrocarbons. In: Goldfrank's Toxicologic Emergencies. 6th ed. 1998:1383-95.

  12. Ureta Raroque SS, Wiebe RA. Household products and environmental toxins. In: Essentials of Pediatric Intensive Care. 2nd ed. 1997:908-35.

  13. Wax PM, Beuhler MB. Hydrocarbons and volatile substances. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004:1124-9.

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Further Reading

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Keywords

hydrocarbon toxicity, hydrocarbon aspiration, hydrocarbon poisoning, gasoline, turpentine, furniture polish, household cleansers, propellants, kerosene, pine oil, sniffing, huffing, bagging, aspiration pneumonitis, hemorrhage, hyperemia, edema, surfactant inactivation, leukocyte infiltration, vascular thrombosis, acute respiratory distress syndrome, ARDS, renal failure, cardiomyopathy

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Contributor Information and Disclosures

Author

Randy J Goldstein, MD, Emergency Department Medical Director, Las Palmas Medical Center
Randy J Goldstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William T Zempsky, MD, Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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