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Key Features

  • Toxicity may occur from inhalation of the vapor or as a result of pulmonary aspiration of the liquid during or after ingestion

Clinical Findings

  • Acute manifestations of aspiration pneumonitis

    • Vomiting

    • Coughing

    • Bronchopneumonia

  • With some hydrocarbons (eg, phenol, carbon tetrachloride), severe systemic poisoning can occur after oral ingestion

  • Systemic intoxication can also occur by inhalation of volatile hydrocarbons

  • Vertigo, muscular incoordination, irregular pulse, myoclonus, and seizures occur with serious poisoning and may be due to hypoxemia or the systemic effects of the agents

  • Chlorinated and fluorinated hydrocarbons (eg, trichloroethylene, freons) and many other hydrocarbons can cause ventricular arrhythmias because of increased sensitivity of the myocardium to the effects of endogenous catecholamines

Diagnosis

  • Coughing or choking immediately after ingestion suggests pulmonary aspiration

  • Chest film findings may be delayed for several hours

  • Chronic toluene abuse associated with renal tubular acidosis, hypokalemia

Treatment

  • Move the patient to fresh air

  • Administration of activated charcoal (60–100 g mixed in aqueous slurry orally or via gastric tube) may be helpful if the preparation contains toxic solutes (eg, an insecticide) or is an aromatic or halogenated product

  • Observe the victim for 6–8 h for signs of aspiration pneumonitis

  • Corticosteroids are not recommended

  • If fever occurs, give a specific antibiotic only after identification of the bacterial pathogens

  • Because of the risk of arrhythmias, use bronchodilators with caution in patients with chlorinated or fluorinated solvent intoxication

  • If tachyarrhythmias occur, use esmolol 25–100 mcg/kg/min intravenously

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