Hydrocarbon Toxicity Treatment & Management

• Prehospital care should focus on decontamination, followed by immediate transport to a medical facility capable of managing such a patient. GI decontamination has no role in prehospital care. Decontamination should focus on removing any remaining hydrocarbon that might be on the clothes or skin, in the correct clinical setting.
• Patients should be kept calm to prevent arrhythmia as a result of myocardial sensitization.
• All patients should have their airway, breathing, and circulation managed per routine advanced life support protocols.
• Symptomatic patients should receive intravenous access and cardiac monitoring.
• The hydrocarbon agent should be transported with the patient to the hospital, if this can be done in a safe manner. Bringing the substance to the hospital can permit identification.

Management for hydrocarbon intoxication is largely supportive.

Asymptomatic patients should be observed with continual pulse-oximetry for a period of at least 6 hours. If the patient remains asymptomatic (eg, no coughing, vomiting, tachypnea, or other evidence of respiratory difficulties), then a chest radiograph may be obtained to evaluate for aspiration.

Other etiologies of altered mental status should be investigated as deemed clinically appropriate by the treating clinician.

Patients who show signs of impending respiratory failure despite supplemental oxygen may require rapid sequence intubation for definitive airway management. Intubation and positive pressure ventilation may be required for evidence of on-going respiratory distress.

If arrhythmias occur, electrolytes, including magnesium and potassium, should be replaced.

If ventricular fibrillation occurs, and the thought is that the arrhythmia is because of myocardial sensitization, catecholamines, including epinephrine, should be avoided. In this setting, lidocaine or beta-blockers can be used.

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.

The hydrocarbons with significant systemic toxicity for which the benefits of gastric decontamination may outweigh the real risks of inducing aspiration follow the mnemonic CHAMP:

• Camphor (toxicity is seizures)
• Halogenated hydrocarbons (toxicity is arrhythmias and hepatotoxicity)
• Aromatic hydrocarbons (toxicity is CNS toxicity, myelosuppression, and malignancy)
• Metals (heavy metals)
• Pesticides (cholinergic symptoms, seizures)

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.

• All hydrocarbon ingestions should be discussed with the regional poison control center (800-221-1222) or a medical toxicologist.
• Psychiatry consultation should be performed if deemed clinically relevant.