Kerosene Poisoning

KEROSENE POISONING

(Hydrocarbons-petroleum distillates poisoning)

Hydrocarbons are derivatives of crude petroleum and are mixtures of aromatic and aliphatic hydrocarbons. They include gasoline, kerosene (common India), lighter fluid, paint thinner, turpentine, mineral seed oil (furniture polish) and pine oil.

AETIOLOGY -

Age 1 to 5— Accidental, in adolescents can be suicidal

TOXIC EFFECTS -

Aspiration - Major danger. The more highly volatile the hydrocarbon, the more likely the aspiration. Major effect of aspiration is chemical irritation, which damages the alveolar wall and the capillaries, causing pneumonitis, atelectasis, or pulmonary oedema. Degree of lung involvement is parallel to degree of clinical compromise. Results are severe hypoxaemia and ventilation - perfusion abnormalities, causing respiratory acidosis. Because of this risk

emesis should not be induced in management of volatile hydrocarbon ingestion.

CNS depression - All hydrocarbons are absorbed to some degree. Amount absorbed decides the CNS

manifestations. Aromatic distillates (toluene, xylene, turpentine, gasoline, mineral spirits) are most likely to cause CNS depression (depressed sensorium).

CLINICAL FEATURES -

Initially there is burning in mouth and throat; choking and gagging, coughing, nausea, vomiting and hemoptysis.

Tachycardia and tachypnea reflect the degree of pulmonary insult. Chest X-ray may show changes before clinical findings. X-ray may reveal punctate, mottled densities of pneumonitis, atelectasis or both with findings tending to

be more prominent in dependent portion of lung. X-ray findings are peak at 72 hours and then begin to clear.

One hour after ingestion, symptoms of CNS depression occur (e.g. generalised weakness, hypotonia, dizziness,

mental confusion, lethargy). Irritability, agitation or convulsions may occur.

Poor co-relation between clinical symptoms, physical findings and radiographic abnormalities.

Complications - LRTI, pneumatocoele, pleural effusion, renal and CNS involvement

TREATMENT -

When a small amount - a mouthful or two - has been ingested the child is best left without attempts at removal in an upright position.

In large ingestions, spontaneous vomiting will usually occur. Comatose patients should be intubated with a cuffed endotracheal tube and then gastric lavage can be given.All patients with respiratory or CNS depression should be admitted to the hospital, observed closely and treated to support respiratory & fluid status. Oxygen, bronchodilators & constant distending airway pressure should be employed.

PREVENTION

Safe storage - prevent easy access of children to petroleum products.

Secure capping of such bottles so that the child is not able to open it even if it desires to do so.