Hydrocarbon Inhalation Injury Medication

Updated: Mar 29, 2017
  • Author: Rakesh Vadde, MBBS; Chief Editor: Denise Serebrisky, MD  more...
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Medication

Medication Summary

For acute inhalant abuse, some authors suggest the use of amiodarone to treat ventricular arrhythmias if used early in treatment. Electrolyte abnormalities should be corrected.

For patients with chronic solvent-inhalant abuse with significant electrolyte abnormalities, typically due to distal renal tubular acidosis, parenteral fluid and electrolyte repletion may be necessary. Correction of potassium and phosphorus deficiency may result in rapid improvement in muscle strength. Hypocalcemia is frequently encountered during fluid and electrolyte repletion.

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Electrolyte replacement agents

Class Summary

These agents are used to correct hypokalemia and hypophosphatemia in inhalation cases. Electrolytes are used to correct disturbances in fluid and electrolyte homoeostasis or acid-base balance and to reestablish osmotic equilibrium of specific ions.

Potassium phosphate/sodium acid phosphate (Neutra-Phos-K, K-Phos)

Preferable to potassium chloride because it allows for correction of both hypokalemia and hypophosphatemia. Contains 4.4 mEq of potassium per 3 mmol of phosphate. Elemental phosphorus equals 31.25 mg/mmol. Should be ordered in millimols of phosphorus, not milliequivalents of potassium, to avoid confusion as to the phosphorus content.

Calcium gluconate

Patients with hypocalcemia may need replacement, particularly in the presence of carpopedal spasm or hypocalcemic seizures. One gram of calcium gluconate equals 90 mg of elemental calcium.

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Anticonvulsants and sedatives

Class Summary

These agents are used for withdrawal symptoms or seizure activity in inhalation cases.

Phenobarbital (Luminal, Solfoton)

Most helpful if withdrawal symptoms are evident. Can be continued for sedation for 5-10 d. Therapeutic level is 15-40 mg/L.

Diazepam (Valium)

Used for sedation if withdrawal symptoms present. Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Individualize dosage and increase cautiously to avoid adverse effects.

Phenytoin (Dilantin)

May act in motor cortex where may inhibit spread of seizure activity. Activity of brainstem centers responsible for tonic phase of grand mal seizures may also be inhibited. Dose should be individualized. Administer larger dose before retiring if dose cannot be divided equally. Therapeutic level is 10-20 mg/L.

Lorazepam (Ativan)

Sedative hypnotic with short onset of effects and relatively long half-life. By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. Important to monitor patient's blood pressure after administering dose. Adjust as necessary.

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Antiarrhythmic agents

Class Summary

These agents may be required to treat tachycardias.

Amiodarone (Cordarone)

Class III antiarrhythmic. Has antiarrhythmic effects that overlap all 4 Vaughn-Williams antiarrhythmic classes. May inhibit AV conduction and sinus node function. Prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation. Only agent proven to reduce incidence and risk of cardiac sudden death, with or without obstruction to LV outflow. Very efficacious in converting atrial fibrillation and flutter to sinus rhythm and in suppressing recurrence of these arrhythmias.

Has low risk of proarrhythmia effects, and any proarrhythmic reactions are generally delayed. Used in patients with structural heart disease. Most clinicians are comfortable with inpatient or outpatient loading with 400 mg PO tid for 1 wk because of low proarrhythmic effect, followed by weekly reductions with goal of lowest dose with desired therapeutic benefit (usual maintenance dose for AF 200 mg/d). During loading, patients must be monitored for bradyarrhythmias. Before administration, control the ventricular rate and CHF (if present) with digoxin or calcium channel blockers.

PO efficacy may take weeks. With exception of disorders of prolonged repolarization (eg, LQTS), may be DOC for life-threatening ventricular arrhythmias refractory to beta blockade and initial therapy with other agents.

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