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Hydrocarbon Ingestion
Aka: Hydrocarbon Ingestion, Hydrocarbon Aspiration, Motor Oil Ingestion, Gasoline Ingestion, Lighter Fluid Ingestion, Petroleum Product Poisoning, Halogenated Hydrocarbon, Aromatic Hydrocarbon, Aliphatic hydrocarbon, Toxic Effect of Hydrocarbon Gas, Toxic Effect of Petroleum
- See Also
- Toxin Ingestion
- Caustic Ingestion
- Definitions
- Hydrocarbon Ingestion
- Broad class of compounds
- Examples: Motor oil, gasoline or Lighter Fluid Ingestion
- Epidemiology
- Acute toxic exposures in U.S.: 28,000 per year (50% are pediatric)
- Intentional (e.g. Huffing, Suicide) in 15% of cases
- Occupational Asthma
- Pathophysiology
- Types of hydrocarbons
- Straight or branched chain hydrocarbons (aliphatic)
- Ring shaped hydrocarbons (aromatic)
- Halogenated Hydrocarbons
- Toxicity
- Rapidly absorbed into the cellular lipid bilayer
- Interacts with cellular functionality
- Routes of Injury
- Chemical Burns to skin
- Ingestion (and aspiration risk, esp. in first 30 minutes)
- Inhalation Injury
- Precautions
- Aspiration into lungs (with Vomiting) is greatest risk
- Common complication of ingestion with Vomiting (esp. in first 30 minutes of ingestion)
- Suspect aspiration if presents with coughing, gagging, Choking, respiratory distress, Hypoxia
- Aspiration is more likely with less viscous, low surface tension, high volatility hydrocarbons
- Gasoline
- Kerosene
- Naphtha
- High viscosity aspirations (e.g. motor oil) are less likely except in decreased airway protection (low GCS)
- Hydrocarbons are directly toxic to pneumocytes (which produce surfactant)
- Results in pneumocyte destruction, non-compliant lungs and ARDS
- Findings: All Hydrocarbons
- Cardiovascular dysfunction
- Hypertension
- Tachyarrythmias (including Ventricular Tachycardia)
- Catecholamine surge
- Fever
- Hypertension
- Tachycardia
- Myocardial sensitization to Catecholamines and prolonged cardiac depolarization
- Risk of QTc Prolongation (risk of Ventricular Tachycardia, Torsades de Pointes)
- Common with Halogenated Hydrocarbons (e.g. chloroform)
- May occur with other hydrocarbons
- Pulmonary
- Pneumonitis
- Pulmonary Edema
- Asphyxia
- Neurologic
- Lethargy to Coma
- Seizures
- Euphoria
- Hallucinations
- Findings: Specific Hydrocarbons
- Amyl nitrite
- Methemoglobinemia
- Chlorinated hydrocarbons
- Hepatic Dysfunction
- Chlorofluorocarbons
- Cold Injury
- Pulmonary Edema
- Methylene Chloride (Dichloromethane)
- Carbon Monoxide Poisoning
- N-Hexane
- Neuropathy
- Toluene (e.g. Huffing)
- Hypokalemia
- Acute Kidney Injury
- Hepatotoxicity
- High Anion Gap Metabolic Acidosis
- Altered Mental Status
- Ataxia
- Labs
- See Unknown Ingestion
- Complete Blood Count
- Comprehensive metabolic panel
- Serum Magnesium
- Venous Blood Gas (or Arterial Blood Gas)
- Urinalysis
- Urine Toxicology Screening
- Imaging
- Chest XRay
- Demonstrates aspiration findings within 6 hours in 90% of volatile Hydrocarbon Aspirations
- Diagnostics
- Electrocardiogram
- Telemetry monitoring
- Management
- Decontamination
- Use soap and water (except in phenol exposure)
- Use topical Polyethylene glycol for phenol exposure
- Avoid charcoal
- Not effective and risk of further aspiration
- Avoid Nasogastric Tube in most Hydrocarbon Ingestions (NG ineffective)
- Exceptions: Organophosphates, carbon tetrachloride, Benzene, methylene chloride
- ABC Management with Primary Survey and Secondary Survey
- Evaluate for aspiration with secondary respiratory and airway compromise
- Evaluate for hemodynamic instability
- Evaluate for decreased mental status
- Consider Endotracheal Intubation (see Advanced Airway for indications)
- Normalize electolyte abnormalities
- Correct Serum Potassium
- Correct Serum Magnesium
- Consider nebulized Bronchodilators (e.g. Albuterol)
- Avoid systemic Terbutaline (may worsen tachydysrhythmia)
- Avoid Corticosteroids (not effective)
- Stabilize Hypotension
- Fluid Resuscitation
- Avoid strong Beta adrenergic Vasopressors (e.g. Epinephrine, Dopamine)
- Decrease Positive End-Expiratory Pressure (PEEP)
- Consider Intravenous Phenylephrine if Vasopressor needed
- Manage Ventricular Arrhythmias
- Follow ACLS Protocol for Ventricular Fibrillation or Ventricular Tachycardia (with the following exceptions)
- Avoid Epinephrine
- Employ Antiarrhythmics (e.g. Amiodarone, Lidocaine) early
- Consider Beta Blocker in refractory ventricular Arrhythmia (decreases myocardial Hypersensitivity)
- Consider Esmolol 500 mcg/kg IV bolus, followed by 50 mcg/kg/min
- Disposition
- Observe asymptomatic patients for 6 hours
- Obtain repeat Chest XRay at 6 hours
- If no signs or symptoms of aspiration at 6 hours, typically safe to discharge
- Arrange transfer to higher level of care if signs of aspiration
- ECMO may be considered
- Exogenous surfactant has been used
- Complications
- Chronic neurologic hematologic or oncologic sequelae
- References
- Swadron and Nordt in Herbert (2017) EM:Rap 17(7): 14
- Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27