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

Toxicity, Hydrocarbons: Treatment & Medication

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

Updated: Dec 9, 2008

Treatment

Medical Care

  • ABCs: Stabilization of the airway is always the first priority of treatment in patients with hydrocarbon poisoning. 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 a patient in whom oxygenation is inadequate or in a patient who has 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.
  • Cutaneous decontamination in cases of cutaneous exposure: Decontaminate the skin as soon as possible by removing the involved clothing and thoroughly washing the skin with soap and water. Vapor inhalation and cutaneous absorption may occur long after the exposure. Health care providers must take precautionary action to minimize their own exposure to the toxic substance.
  • Gastric decontamination in cases of oral ingestion
    • Gastric decontamination is controversial. If gastric decontamination is considered, the airway must be stabilized to minimize the risk of aspiration secondary to the patient's vomiting.
    • Because a major complication of hydrocarbon ingestion is aspiration, reserve the use of gastric decontamination for only cases of large intentional ingestions or those involving an increased risk of systemic toxicity.
    • Gastric decontamination includes the induction of emesis by administering ipecac syrup and then gastric lavage.
      • The use of ipecac syrup is rarely indicated to induce emesis; exceptions involve situations in which the patient's mental status is within normal limits and in which a large volume of a known toxic substance has been ingested. Never induce emesis after the ingestion of a low-viscosity hydrocarbon (eg, gasoline, kerosene, furniture polish, mineral spirits) because the aspiration risk is high. The induction of emesis is rarely indicated in children because they usually do not ingest a large volume.
      • Regarding gastric lavage, the risk and complications of aspiration outweigh the benefits. If lavage is attempted, nasogastric lavage is advised because the ingested substance is a liquid, and the use of a large-caliber orogastric tube greatly increases the risk of vomiting and aspiration. Lavage is useful in cases in which the hydrocarbon has an inherent systemic toxicity or contains additives with known toxicity.
      • A useful mnemonic for remembering such hydrocarbons is CHAMP, which stands for the following: camphor, halogenated hydrocarbons, aromatic hydrocarbons, (heavy) metal-containing hydrocarbons, and pesticide-containing hydrocarbons.
      • 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. The use of activated charcoal is indicated in cases of a suicide attempt or in cases in which another adsorbable toxic substance have been co-ingested.

Consultations

  • Contact the local poison control center in all hydrocarbon ingestions.
  • Consult a psychiatrist, psychologist, or other mental health professional if the exposure was a result of a suicide attempt.
  • A substance abuse professional may provide assistance in cases of recreational or long-term hydrocarbon abuse.

Medication

No specific antidotes are available for hydrocarbon poisoning. Treatment with corticosteroids and prophylactic antibiotics is not beneficial. In some cases, steroids may be harmful.

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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