38-51: Petroleum Distillates & Solvents Poisoning

Petroleum distillate toxicity may occur from inhalation of the vapor or as a result of pulmonary aspiration of the liquid during or after ingestion. Acute manifestations of aspiration pneumonitis are vomiting, coughing, and bronchopneumonia. Some hydrocarbons—ie, those with aromatic or halogenated subunits—can also cause severe systemic poisoning after oral ingestion. Hydrocarbons can also cause systemic intoxication by inhalation. 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 (trichloroethylene, Freons, etc) and many other hydrocarbons can cause ventricular arrhythmias due to increased sensitivity of the myocardium to the effects of endogenous catecholamines.

TREATMENT

Remove the patient to fresh air. For simple aliphatic hydrocarbon ingestion, gastric emptying and activated charcoal are not recommended, but these procedures may be indicated if the preparation contains toxic solutes (eg, an insecticide) or is an aromatic or halogenated product. Observe the patient for 6–8 hours for signs of aspiration pneumonitis (cough, localized crackles or rhonchi, tachypnea, and infiltrates on chest radiograph). Corticosteroids are not recommended. If fever occurs, give a specific antibiotic only after identification of bacterial pathogens by laboratory studies. Because of the risk of arrhythmias, use bronchodilators with caution in patients with chlorinated or fluorinated solvent intoxication. If tachyarrhythmias occur, use esmolol intravenously 25–100 mcg/kg/minute.