Hydrocarbon Ingestion

Aka: Hydrocarbon Ingestion, Hydrocarbon Aspiration, Motor Oil Ingestion, Gasoline Ingestion, Lighter Fluid Ingestion, Petroleum Product Poisoning, Hydrocarbon, Halogenated Hydrocarbon, Aromatic Hydrocarbon, Aliphatic hydrocarbon, Toxic Effect of Hydrocarbon Gas, Toxic Effect of Petroleum

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II. Definitions

  1. Hydrocarbon
    1. Molecules composed of a core carbon chain (open chain or or cyclic)
    2. Carbon chain is bound to hydrogen, as well as other elements (e.g. Oxygen, Nitrogen, Sulfur)
    3. Hydrocarbons are either aromatic or aliphatic
  2. Halogenated Hydrocarbon
    1. Hydrocarbons in which a hydrogen is substituted with halogen
    2. Examples: Chloroform, trichloroethylene
  3. Aromatic Hydrocarbon
    1. Cyclic chain (carbon rings, typically hexagonal)
    2. Examples: Benzene, Toluene, Phenol
  4. Aliphatic hydrocarbon
    1. Includes all open chain Hydrocarbons, as well as branched chain Hydrocarbons
    2. Saturated Aliphatic hydrocarbons contain all single bonds (alkanes)
    3. Unsaturated Aliphatic hydrocarbons contain double bonds (alkenes) or triple bonds (alkynes)
    4. Examples include molecules distilled from petroleum
      1. Gasoline
      2. Motor oil
      3. Lighter fluid
      4. Lamp oil
      5. Furniture polish
      6. Paint thinner

III. Epidemiology

  1. Acute toxic exposures in U.S.: 28,000 per year (50% are pediatric)
    1. Intentional (e.g. Huffing, Suicide) in 15% of cases
    2. Occupational Asthma

IV. Pathophysiology

  1. Types of Hydrocarbons (see definitions above)
    1. Straight or branched chain Hydrocarbons (aliphatic)
    2. Ring shaped Hydrocarbons (aromatic)
    3. Halogenated Hydrocarbons
  2. Toxicity
    1. Rapidly absorbed into the cellular lipid bilayer
    2. Interacts with cellular functionality
  3. Routes of Injury
    1. Chemical Burns to skin
    2. Ingestion (and aspiration risk, esp. in first 30 minutes)
    3. Inhalation Injury

V. Precautions

  1. Aspiration into lungs (with Vomiting) is greatest risk
    1. Common complication of ingestion with Vomiting (esp. in first 30 minutes of ingestion)
    2. Suspect aspiration if presents with coughing, gagging, Choking, respiratory distress, Hypoxia
    3. Aspiration is more likely with less viscous, low surface tension, high volatility Hydrocarbons
      1. Gasoline
      2. Kerosene
      3. Naphtha
    4. High viscosity aspirations (e.g. motor oil) are less likely except in decreased airway protection (low GCS)
  2. Hydrocarbons are directly toxic to pneumocytes (which produce surfactant)
    1. Results in pneumocyte destruction, non-compliant lungs and ARDS

VI. Findings: All Hydrocarbons

  1. Cardiovascular dysfunction
    1. Hypertension
    2. Tachyarrythmias (including Ventricular Tachycardia)
    3. Catecholamine surge
      1. Fever
      2. Hypertension
      3. Tachycardia
    4. Myocardial sensitization to Catecholamines and prolonged cardiac depolarization
      1. Risk of QTc Prolongation (risk of Ventricular Tachycardia, Torsades de Pointes)
      2. Common with Halogenated Hydrocarbons (e.g. chloroform)
      3. May occur with other Hydrocarbons
  2. Pulmonary (aspiration of low viscosity agent destroys surfactant producing cells)
    1. See Huffing
    2. Cough
    3. Dyspnea
    4. Pneumonitis
    5. Pulmonary Edema
    6. Asphyxia
  3. Neurologic (related to general Anesthetic effects of Hydrocarbons)
    1. Lethargy to Coma
    2. Seizures
    3. Euphoria
    4. Hallucinations
    5. Slurred speech
    6. Disorientation
    7. Dizziness
    8. Ataxia
  4. Gastrointestinal
    1. Nausea
    2. Vomiting
    3. Abdominal Pain
    4. Diarrhea
  5. Skin
    1. Risk of Burn Injury, defatting with spills and skin exposure

VII. Findings: Specific Hydrocarbons

  1. Amyl nitrite
    1. Methemoglobinemia
  2. Chlorinated Hydrocarbons
    1. Hepatic Dysfunction
  3. Chlorofluorocarbons
    1. Cold Injury
    2. Pulmonary Edema
  4. Methylene Chloride (Dichloromethane)
    1. Carbon Monoxide Poisoning
  5. N-Hexane
    1. Neuropathy
  6. Toluene (e.g. Huffing)
    1. Hypokalemia
    2. Acute Kidney Injury
    3. Hepatotoxicity
    4. High Anion Gap Metabolic Acidosis
    5. Altered Mental Status
    6. Ataxia

VIII. Labs

  1. See Unknown Ingestion
  2. Complete Blood Count
  3. Comprehensive metabolic panel
  4. Serum Magnesium
  5. Venous Blood Gas (or Arterial Blood Gas)
  6. Urinalysis
  7. Urine Toxicology Screening

IX. Imaging

  1. Chest XRay
    1. Demonstrates aspiration findings within 6 hours in 90% of volatile Hydrocarbon Aspirations

X. Diagnostics

  1. Electrocardiogram
  2. Telemetry monitoring

XI. Management

  1. Decontamination
    1. Use soap and water (except in phenol exposure)
    2. Use topical Polyethylene glycol for phenol exposure
    3. Avoid charcoal
      1. Not effective and risk of further aspiration
    4. Avoid Nasogastric Tube in most Hydrocarbon Ingestions (NG ineffective)
      1. Exceptions: Organophosphates, carbon tetrachloride, Benzene, methylene chloride
  2. ABC Management with Primary Survey and Secondary Survey
    1. Monitor full Vital Signs including Oxygen Saturation
    2. Evaluate for aspiration with secondary respiratory and airway compromise
    3. Evaluate for hemodynamic instability
    4. Evaluate for decreased mental status
    5. Consider Endotracheal Intubation (see Advanced Airway for indications)
  3. Toxicology
    1. See Unknown Ingestion for toxicologic evaluation
    2. Consider life threatening coingestions
      1. Camphor
      2. Other Hydrocarbon (aliphatic or Aromatic Hydrocarbon, Halogenated Hydrocarbon)
      3. Metals
      4. Pesticides
  4. Normalize electolyte abnormalities
    1. Correct Serum Potassium
    2. Correct Serum Magnesium
  5. Consider nebulized Bronchodilators (e.g. Albuterol)
    1. Avoid systemic Terbutaline (may worsen tachydysrhythmia)
    2. Avoid Corticosteroids (not effective)
  6. Stabilize Hypotension
    1. Fluid Resuscitation
    2. Avoid strong Beta adrenergic Vasopressors (e.g. Epinephrine, Dopamine)
    3. Decrease Positive End-Expiratory Pressure (PEEP)
    4. Consider Intravenous Phenylephrine if Vasopressor needed
  7. Manage Ventricular Arrhythmias
    1. Follow ACLS Protocol for Ventricular Fibrillation or Ventricular Tachycardia (with the following exceptions)
    2. Avoid Epinephrine
    3. Employ Antiarrhythmics (e.g. Amiodarone, Lidocaine) early
    4. Consider Beta Blocker in refractory ventricular Arrhythmia (decreases myocardial Hypersensitivity)
      1. Consider Esmolol 500 mcg/kg IV bolus, followed by 50 mcg/kg/min
  8. Disposition
    1. Admit all patients with persistent respiratory or neurologic effects
    2. Observe asymptomatic patients for 6 hours
      1. Obtain repeat Chest XRay at 6 hours
      2. If no signs or symptoms of aspiration at 6 hours, typically safe to discharge
    3. Arrange transfer to higher level of care if signs of aspiration
      1. ECMO may be considered
      2. Exogenous surfactant has been used in aspiration cases

XII. Complications

  1. Chronic neurologic hematologic or oncologic sequelae

XIII. References

  1. Swadron and Nordt in Herbert (2017) EM:Rap 17(7): 14
  2. Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27
  3. Tomaszewski (2022) Crit Dec Emerg Med 36(5): 32

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Related Studies

Ontology: Hydrocarbons (C0020242)

Definition (NCI_NCI-GLOSS) A substance made of only hydrogen and carbon. Examples of hydrocarbons are coal, petroleum, natural gas and tar. They are used as energy sources. Being exposed to hydrocarbons may increase the risk of certain types of cancer.
Definition (NCI) A group of organic compounds that consist of only hydrogen (H) and carbon (C) atoms and are involved in energy production. They may be cyclic or non-cyclic compounds. They may have double bonds, single bonds or both with carbon forming the backbone.
Definition (CSP) organic compound that contains carbon and hydrogen only.
Concepts Organic Chemical (T109)
MSH D006838
SnomedCT 80382003
LNC LP31750-0
English Hydrocarbons, Hydrocarbons [Chemical/Ingredient], hydrocarbon, hydrocarbons, Hydrocarbon, Hydrocarbon (substance), Hydrocarbon, NOS
Swedish Kolväten
Czech uhlovodíky
Finnish Hiilivedyt
Russian UGLEVODORODY, УГЛЕВОДОРОДЫ
Croatian UGLJIKOVODICI
Polish Węglowodory
Norwegian Hydrokarboner
Spanish hidrocarburo (sustancia), hidrocarburo, Hidrocarburos
French Hydrocarbures
German Kohlenwasserstoffe
Italian Idrocarburi
Portuguese Hidrocarbonetos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hydrocarbons, Aromatic (C0020245)

Definition (MSH) Organic compounds containing carbon and hydrogen in the form of an unsaturated, usually hexagonal ring structure. The compounds can be single ring, or double, triple, or multiple fused rings.
Concepts Organic Chemical (T109)
MSH D006841
SnomedCT 34862004
English Hydrocarbons, Aromatic, Aromatic Hydrocarbons, Hydrocarbons, Aromatic [Chemical/Ingredient], aromatic hydrocarbons, aromatic hydrocarbon, Aromatic hydrocarbon, Aromatic hydrocarbon (substance), Aromatic hydrocarbon, NOS, Aromatic Hydrocarbon
Swedish Kolväten, aromatiska
Czech uhlovodíky aromatické
Finnish Aromaattiset hiilivedyt
Russian UGLEVODORODY AROMATICHESKIE, AROMATICHESKIE UGLEVODORODY, АРОМАТИЧЕСКИЕ УГЛЕВОДОРОДЫ, УГЛЕВОДОРОДЫ АРОМАТИЧЕСКИЕ
Croatian Not Translated[Hydrocarbons, Aromatic]
Polish Węglowodory aromatyczne
Japanese 芳香族炭化水素, 炭化水素-芳香族
Norwegian Not Translated[Hydrocarbons, Aromatic]
Spanish hidrocarburo aromático (sustancia), hidrocarburo aromático, Hidrocarburos Aromáticos
French Hydrocarbures aromatiques
German Aromatische Kohlenwasserstoffe, Kohlenwasserstoffe, aromatische
Italian Idrocarburi aromatici
Portuguese Hidrocarbonetos Aromáticos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hydrocarbons, Halogenated (C0020250)

Definition (NCI) Compounds consisting of carbon, hydrogen, and one or more halogen.
Definition (CSP) organic compound that contains carbon and hydrogen, with halogen atoms substituting for one or more hydrogens.
Concepts Organic Chemical (T109)
MSH D006846
SnomedCT 41105002
LNC LP18116-1, MTHU003406
English Halogenated Hydrocarbons, Hydrocarbons, Halogenated, halohydrocarbon, Hydrocarbons, Halogenated [Chemical/Ingredient], halogenated hydrocarbons, Hydrocarbons.halogenated, Halocarbons, Halogenated hydrocarbon, Halogenated hydrocarbon (substance), Halogenated hydrocarbon, NOS, Halogenated Hydrocarbon
Swedish Kolväten, halogenerade
Czech uhlovodíky halogenované
Finnish Halogenoidut hiilivedyt
Russian GALOGENIROVANNYE UGLEVODORODY, UGLEVODORODY GALOGENIROVANNYE, ГАЛОГЕНИРОВАННЫЕ УГЛЕВОДОРОДЫ, УГЛЕВОДОРОДЫ ГАЛОГЕНИРОВАННЫЕ
Croatian Not Translated[Hydrocarbons, Halogenated]
Polish Chlorowcopochodne węglowodorów, Węglowodory fluorowcowane, Węglowodory halogenowe
Japanese 炭化水素-ハロゲン化, ハロゲン化炭化水素
Spanish hidrocarburo halogenado (sustancia), hidrocarburo halogenado, Hidrocarburos Halogenados
French Hydrocarbures halogénés
German Halogenierte Kohlenwasserstoffe, Kohlenwasserstoffe, halogenierte
Italian Idrocarburi alogenati
Portuguese Hidrocarbonetos Halogenados
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Toxic effect of petroleum product (C0161685)

Concepts Injury or Poisoning (T037)
ICD9 981
ICD10 T52.0 , T52.0X, T52.0X1
SnomedCT 62623004, 212822007, 157687009, 86772005
English Toxic effect of petroleum products, Petrol prod causing tox effect, Petroleum prod.-toxic eff.NOS, Petroleum product causing toxic effect, Petroleum product causing toxic effect NOS, Petroleum products, poisoning by petroleum products, poisoning by petroleum products (diagnosis), Toxic eff petroleum prod, Toxic effects of petroleum products, Toxic effects of petroleum products NOS, Toxic effect of petroleum product, Petroleum poisoning (disorder), Petroleum product causing toxic effect NOS (disorder), Petroleum product causing toxic effect (disorder), Petroleum poisoning, Petroleum product toxicity, Toxic effect of petroleum product (disorder), Toxic effect of petroleum product, NOS, Petroleum poisoning -RETIRED-
Dutch toxisch gevolg van aardolieproducten, Aardolieproducten
French Effets toxiques des produits à base de pétrole
German toxische Wirkung von Petroleumprodukten, Toxische Wirkung: Erdoelprodukte
Italian Effetti tossici dei derivati del petrolio
Portuguese Efeito tóxico de produtos do petróleo
Spanish Efecto tóxico de productos derivados del petróleo, producto del petróleo que produce efecto tóxico, SAI, toxicidad por producto del petróleo, intoxicación por petróleo - RETIRADO -, intoxicación por petróleo - RETIRADO - (concepto no activo), producto del petróleo que produce efecto tóxico, SAI (trastorno), efecto tóxico de producto derivado del petróleo (trastorno), efecto tóxico de producto derivado del petróleo
Japanese 石油製品の毒作用, ｾｷﾕｾｲﾋﾝﾉﾄﾞｸｻﾖｳ
Czech Toxický účinek ropných produktů
Korean 석유제품의 중독작용
Hungarian Kőlolajtermékek toxikus hatása
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Toxic effect of hydrocarbon gas (C0413003)

Concepts Injury or Poisoning (T037)
SnomedCT 111776002
English Gas hydrocarbn caus tox effect, Gaseous hydrocarbon causing toxic effect, Toxic effect of hydrocarbon gas (disorder), Toxic effect of hydrocarbon gas
Spanish efecto tóxico de hidrocarburo gaseoso (trastorno), efecto tóxico de hidrocarburo gaseoso, efecto tóxico del gas de hidrocarburo, hidrocarburo gaseoso que causa efecto tóxico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Aliphatic hydrocarbon (C0682921)

Concepts Organic Chemical (T109)
SnomedCT 117496002
LNC LP18885-1, MTHU006770
English aliphatic hydrocarbon, aliphatic hydrocarbons, Hydrocarbons.aliphatic, Aliphatic hydrocarbon (substance), Aliphatic hydrocarbon
Spanish hidrocarburo alifático (sustancia), hidrocarburo alifático
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Poisoning and Toxicology

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