Hydrocarbons Toxicity Follow-up

  • Author: Randy J Goldstein, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 21, 2011
 

Further Inpatient Care

  • Patients with hydrocarbon poisoning may be safely discharged home if all of the following conditions are met:
    • They have been observed in the emergency department for at least 6 hours.
    • They are asymptomatic.
    • Their chest radiographic findings are normal.
    • They are instructed to return if respiratory symptoms develop.
  • Patients who have respiratory symptoms consistent with hydrocarbon aspiration should be observed or admitted to the hospital for at least 12 hours. Patients whose respiratory symptoms improve during this time may be safely discharged home.
  • Patients who have respiratory distress and require mechanical ventilation should be admitted to an intensive care unit.
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Deterrence/Prevention

  • For primary prevention, see Patient Education.
  • Inhalant abuse occurs in adolescents and adults and should be deterred. Hydrocarbons may be inhaled for recreation, similar to drugs and alcohol. Hydrocarbons might also be inhaled as part of suicidal gestures and attempts.
    • Treatment of the underlying causes of these behaviors might help in preventing hydrocarbon use.
    • Maintain a high index of suspicion with any adolescent who has signs of alcohol intoxication or recreational drug use.
    • Immediately address any suspicions of inhalation abuse with the patient's parent or regular physician.
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Complications

  • Aspiration pneumonitis is the most common complication of hydrocarbon ingestion, followed by CNS and cardiovascular complications. The major respiratory complications are aspiration and lung injury secondary to pneumonitis. Pneumothoraces and barotrauma are potential complications of mechanical ventilation. Most patients improve after 24 hours, and symptoms resolve within 1 week.
  • CNS complications include seizures, encephalopathy, and memory loss. These sequelae are usually believed to be secondary to a hypoxic insult.
  • Myocarditis and cardiomyopathy are reported cardiovascular complications of hydrocarbon toxicity.
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Prognosis

  • With appropriate supportive care, most patients recover without residual complications.
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Patient Education

  • Patient education is crucial in the prevention of unnecessary or accidental exposure.
  • Most exposures in young children are accidental and can be prevented.
    • Parents should teach young children about the dangers of poisons, beginning at an early age.
    • Advise the parents about the proper storage and labeling of harmful chemicals.
    • Inform parents about common household products that may be dangerous, and recommend steps that they can take to minimize the possibility of an accidental exposure.
    • Educate parents that they need to supervise their children when they are in high-risk areas (eg, kitchen, garage, laundry room) where toxic substances may be present.
    • Provide the parents with the telephone number of their local poison control center.
  • For excellent patient education resources, visit eMedicine's Poisoning - First Aid and Emergency Center and Substance Abuse Center. Also, see eMedicine's patient education articles Poisoning, Poison Proofing Your Home, and Substance Abuse.
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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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

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.

References

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  2. Hesterberg TW, Long CM, Sax SN, Lapin CA, McClellan RO, Bunn WB, et al. Particulate matter in new technology diesel exhaust (NTDE) is quantitatively and qualitatively very different from that found in traditional diesel exhaust (TDE). J Air Waste Manag Assoc. Sep 2011;61(9):894-913. [Medline].

  3. Birch ME. Exposure and Emissions Monitoring during Carbon Nanofiber Production--Part II: Polycyclic Aromatic Hydrocarbons. Ann Occup Hyg. Nov 2011;55(9):1037-47. [Medline].

  4. 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].

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

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

  7. 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].

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

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

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

  11. 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].

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

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

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

  15. 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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Hydrocarbon pneumonitis.
 
 
 
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