21mths old boy ingested an estimated 20 ml of kerosene at
7:00 p.m on 063/2/15 and was brought to the Patan
/2 hrs post exposure. His mother noticed child
was having fast and noisy breathing however did not recall
him coughing , vomiting or altered sensorium.o/e he was
sick looking restless , kerosene odour was present on his
breath. His vital signs were B.P=90/60 mm hg
pulse=120/min , R/R=62/min,grunting, subcostal retraction
positive. Temp 97.6o
f no cyanosis spo2=100% with 02 The
abdominal, cardiac and pulmonary examination were
remarkable.Chest X-ray taken immediately was negative
for e/o pneumonia. He was kept in observation for 12 hrs
and was discharged on the next day.
• CLASSIFICATION OF HYDROCARBONS
• DETERMINANTS OF TOXICITY
• ETIOLOGICAL FACTORS
• INCIDENCE OF KEROSENE POISONING
• HISTOPATHOLOGY OF LUNG AT AUTOPSY.
• CLINICAL FEATURES
• REVIEW QUESTION
Classification of Hydrocarbons
A) aliphatic e.g. kerosene,lubricating oil, tar
b) aromatic e.g. benzene compounds(xylene
c) halogenated e.g. carbon tetrachloride and
d) cyclic turpenes e.g. turpentine, pine oil
• Substance with <60ssu (saybolt second universal)
i.e low viscosity have high aspiration potential and
those with >100ssu i.e high viscosity have
• Substance with low viscosity are kerosene
mineral spirits, naphtha gasoline and lamp oil.
• Hydrocarbons having high volatility low viscosity
and low surface tension are more likely to be
aspirated and therefore have the greatest toxicity
• Inappropriate storage
• attractive colour
• pleasant odour
• low socioeconomic status
• inquisitive nature
• lack of parental awareness
• hot seasons
• Common in children(13.4%)
• intentional poisoning (58.2%) and
Aspiration of hydrocaron
early distal air way closure
ventilation perfusion mismatch
- interstitial inflammation
-infiltration of polymorphonuclear cells
-bronchial and bronchiolar necrosis
-intraalveolar hemorrhage and edema
• central nervous system
• gastrointestinal tract system
• other organ involvement
tachypnoea ,rales hemoptysis ,gagging
choking ,transient cyanosis,pumonary
edema,continued non productive cough
pnemonia( chemical and bacterial)
• Irritation is common
• spontaneous vomiting
• nausea, diarrhoea and abdominal pain
-other organ involvement is very-other organ involvement is very
rare(DIC, hemolytic anemia andrare(DIC, hemolytic anemia and
even pancytopenia haveeven pancytopenia have
occasionally been reportedoccasionally been reported
following inhalation,aspiration,following inhalation,aspiration,
or ingestion ofor ingestion of
hydrocarbon.Renal effects occurhydrocarbon.Renal effects occur
• chest X-ray-
-may be normal for as long as 8-12
hr. after aspiration, may remain abnormal
long after a patient is clinically normal and
should not be used to guide acute
Note:clinical presentation is better predictor
of clinical course than the chest X-ray
• other- increased transaminases
• HOME TREATMENT
• TREATMENT IN HOSPITAL
• Seek emergency medical care
immediately,call the poison control center
• Donot induce vomiting(emesis)
• determine the following information before
-the patient’s age ,weight and condition
-name of the products(ingredients and
strength, if known)
-the time it was swallowed
-the amount swallowed
•Patient can be managed at home
provided that -
a)patient is asymptomatic
b)there is access to follow up
c)no indication of child
abuse or attempted suicide
TREATMENT IN HOSPITAL
• SUPPORTIVE CARE
• GASTRIC EMPTYING
• ACTIVATED CHARCOAL
• PROPHYLACTIC ANTIBIOTIC
• T/T FOR SKIN EXPOSURE
• T/T FOR PULMONARY EDEM,A
Admission criteria for
• Symptomatic patients(e.g. fever, hypoxia,
dysrrhythmias or respiratory symptoms
• asymptomatic patients with abnormal chest
X-rays s/o aspiration if sufficient home
follow-up cannot be provided.
• Patients who have the potential for delayed
• Cases of attempted suicide or cases
involving ingestion of large amounts of
• Remove contaminated clothing and shower
• Check for aspiration
• administer oxygen
a)induced emesis-in awake ,alert
Note:not done if a single petroleum distillate
is involved because unintentional ingestion
involves small quantities of hydrocarbons
,only very small amount is absorbed
through GI tract.
Condition where gastric emptying is
a)where hydrocarbon is used as
solvent for an other dangerous toxin.
b)when ingested along with an other
c) when large volume of
hydrocarbon(>30 ml) is ingested in a
• Not indicated since little hydrocarbon is
• may aggravate emesis
• doesnot bind aliphatic hydrocarbon
• Also not indicated as little hydrocarbon is
• diarrhoes usually occurs after aliphatic
Role of steroids
• Donot improve the outcome in patients with
• may even be dangerous as they may
increase the risk of super infection.
• Not routinely recommended.
• Justified in following cases:
-predisposing respiratory illness
-patients who are extremely weak
-patients with severe pneumonia
-bacteria involvement is confirmed by
cultures of sputum of blood.
T/t for skin exposure
• Irrigation perhaps of few hrs. for several
• skin debridement of burned skin.
• Admission of transfer to a hospital that
specialises in burn care.
T/t of Pulmonary edema
• Maintenance of adequate ventilation with
close monitoring of Arterial blood gases
• PEEP in intubated patients or CPAP in non-
intubated if PO2 cannot be maintained
>50mmhg with inspiration of 60%O2 by
face mask or mechanical ventilation.
• Pharmacological means.
Prognosis or Expectations
• Extensive damage to the mouth ,throat and
stomach are possible and the ultimate
outcome depends on the extent of this
damage.Damage can continue to occur for
several weeks after hydrocarbon was
• death may occur as long as a months after
hydrocarbon was swallowed.
(Gupta et al. )
Parameter absent present others
Fever 0 1 -
Severe malnutrition 0 1 -
Respiratory distress 0 2 4(presence
Neurological symptoms 0 2 4(presence
Note:score- min-0 and max-10
-if score> 4 or equal-significant risk and
patient to be transferred to centre with of ALS
-if score < 7 or equal- pt. likely to survive
-if score>8 or equal-risk of death several times
-predictive value of this scoring system is 85%
• Symptomatic and supportive care are the main
stay in the management of hydrocarbon exposure.
• Treatments are controversial and individualised.
• Consultation with specialists of the Nepal Poison
information center and its consultants
recommended for all such cases.
• Urge treating physician to provide counselling to
parents of exposed children about poison proofing
their home to prevent recurrences.
• Long term follow of severely symptomatic case
for the development to chronic lung diseases.
Which statement is false?
A.Hydrocarbons with viscosities < 60 SSU are readily aspirated.
B.Kerosene is an example of an aliphatic hydrocarbon.
C.Renal injury occurs in greater than 70% of aliphatic hydrocarbon
D.Activated charcoal is not indicated when the only poison ingested
is an aliphatic hydrocarbon.
E.Steroid have not been show to benefit patients suffering from
aliphatic hydrcarbon induced chemicalpneumonitis.