Petroleum Distillate Poisoning

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