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 dsyrhythmia 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 dysrhythmias occur, electrolytes, including magnesium and potassium, should be replaced.

If ventricular fibrillation occurs, and is thought to reflect myocardial sensitization, treatment with catecholamines, including epinephrine, should be avoided. In this setting, lidocaine or beta-blockers can be used.

Decontamination of the GI tract remains controversial. Activated charcoal does not absorb hydrocarbons well, and gastric lavage should not be routinely performed. The use of ipecac-induced emesis is contraindicated.

However, the benefits of gastric decontamination may outweigh the real risks of inducing aspiration in patients who have ingested hydrocarbons with significant systemic toxicity. These are outlined in the following mnemonic, CHAMP:

• Camphor (toxicity is seizures)

• Halogenated hydrocarbons (toxicity is dysrhythmias 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. However, there is no evidence to support prophylactic administration of antibiotics. ^[13] 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, determining whether those effects represent a superimposed infection or the pneumonitis itself is often difficult. Any abnormal 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.

After a 6-hour observation period during which a patient has a normal chest radiograph and never developed any symptoms (including coughing, vomiting, respiratory difficulty) of hydrocarbon exposure, the patient can be safely discharged home with close follow-up (reevaluation in 24 h).

Patients who develop any symptoms of hydrocarbon exposure during the 6-hour observation should be admitted to a unit capable of continuous pulse oximetry.  Patients should be closely observed for any evidence of respiratory deterioration. Patients with radiographic evidence of pneumonitis should receive repeat chest radiographs every 24 hours (or sooner, if clinically indicated) to ensure that the pneumonitis is not progressing.

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.

Prevention of nonintentional poisonings includes clearly labeling containers that contain hydrocarbons. Prevention of toxicities as a result of recreational drug use includes educating teens about the risks associated with such behavior.