🛢️ Chapter 123: Hydrocarbon Poisoning

Low viscosity (kerosene, petrol) → high aspiration risk · Chemical pneumonitis · ARDS · Contraindications: gastric lavage, activated charcoal, emesis · Supportive care · Oxygen, PEEP, intubation if severe · No steroids · Pneumothorax risk

🔍 Core Concepts: Hydrocarbon Poisoning

📌 High-Risk Hydrocarbons
Low viscosity, low surface tension, high volatility → high aspiration risk. Examples: kerosene, petrol, gasoline, naphtha. Essential oils (eucalyptus, tea tree) also toxic.
⚠️ Aspiration Pneumonitis
Main hazard: chemical pneumonitis (not bacterial). Aspiration can occur during ingestion, vomiting, or gastric lavage. Symptoms: cough, tachypnoea, grunting, hypoxaemia, fever.
🚫 Contraindicated Interventions
Activated charcoal (ineffective, aspiration risk). Gastric lavage (not effective, causes aspiration). Inducing emesis (high risk of aspiration).
🫁 Supportive Care (Mainstay)
100% oxygen. Chest X-ray after 6h (infiltrates may be delayed). NIV or intubation with PEEP for respiratory failure. Avoid high pressures (risk of pneumothorax).
💊 No Role for Steroids/Antibiotics
Steroids not proven beneficial. Antibiotics only if secondary bacterial infection confirmed (not prophylactic). Fever is chemical, not infectious.
🧪 Systemic Toxicity
Aromatic/halogenated hydrocarbons (benzene, toluene, carbon tetrachloride) cause CNS depression, renal/hepatic toxicity. Monitor for arrhythmias (sudden sniffing death).

🩺 Stepwise Approach: Hydrocarbon Ingestion

1
Assess for aspiration (airway, breathing)
Cough, tachypnoea, grunting, retractions, hypoxaemia. Auscultate for rales, wheeze. Obtain chest X-ray (may show infiltrates, perihilar opacities).
2
DO NOT decontaminate the GI tract
No gastric lavage, no activated charcoal, no emesis (all increase aspiration risk). Hydrocarbons not systemically absorbed; aspiration is the danger.
3
Supplemental oxygen & respiratory support
100% oxygen. For hypoxaemia: nasal cannula or mask. NIV (CPAP/BiPAP) for moderate distress. Intubation with PEEP for severe respiratory failure (ARDS).
4
Observe for at least 6-12 hours
Chest X-ray at 6h (may be initially normal but later show infiltrates). Asymptomatic patients can be discharged after 6h observation with normal exam and X-ray.
5
Avoid prophylactic antibiotics & steroids
Fever is chemical, not infectious. Antibiotics only if documented infection. Steroids not beneficial and may worsen outcome.
6
Monitor for complications
Pneumothorax (air leak with high PEEP). ARDS. Halogenated hydrocarbons: arrhythmias, hepatotoxicity, nephrotoxicity.