Eucalyptus Oil Poisoning


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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

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    Key Points

    1. Eucalyptus Oil is highly toxic - even small ingestions of pure oil (≥ 5 ml) can lead to severe symptoms.
    2. Symptom onset is usually rapid (within 30 mins) but can be delayed up to 4 hours after exposure.
    3. CNS depression and respiratory compromise are the main features to monitor for.

    For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26

    Background

    Eucalyptus oil is a popular household product, commonly presented as an essential oil, medicinal product, cleaning product, inhalational/vaporiser fluid or topical preparation.

    Pharmacokinetics:
    Onset within 30 mins to 4 hours post ingestion
    Duration of symptoms: usually resolve within 24 hours

    Dose related toxicity: Even small ingestions of pure oil can lead to severe symptoms.  In a dose of 2-3 ml; can expect mild CNS depression with drowsiness and/or dizziness and ataxia. In a dose of ≥ 5 ml can expect significant CNS depression with coma.

    Patients requiring assessment

    All patients with deliberate self-poisoning or significant accidental ingestion
    Any symptomatic patient
    Dose > 5mL
    Any patient whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.

    Risk Assessment

    History:
    Intentional overdose or accidental

    Dose:
    Stated or likely dose taken
    route of exposure eg inhalation, ingestion, intranasal, topical (consider
    frequent, repeated topical applications).
    Preparation type, if possible determine the exact name and % solution.
    2-3 ml is significant in a child whilst > 5 ml  may be associated with
    severe toxicity.

    Co-ingestants eg paracetamol, other essential oils

    Examination:
    CNS:  CNS depression - drowsiness and dizziness with small exposures, ataxia, seizures, coma with larger (≥ 5 ml) exposures. Miosis or mydriasis can occur, miosis more commonly. Myoclonus has also been reported.

    CVS:  Tachycardia and Hypotension have been reported.

    Respiratory: depression and apnoea, bronchospasm or signs of aspiration pneumonitis.

    GIT: nausea, vomiting and diarrhoea are often present early, epigastric pain.

    Skin: irritation and contact dermatitis

    Investigations:
    Asymptomatic children with small ingestions do not usually require investigation.

    Consider:
    Chest X-ray and blood gas if signs of aspiration pneumonitis
    UEC and LFTs in patient with significant illness or large ingestions

    Paracetamol level in all intentional overdoses

    Acute Management

    1. Resuscitation
    Standard procedures and supportive care

    Aspiration/chemical pneumonitis is managed supportively (Oxygen & bronchodilators – may require non-invasive ventilation or intubation if severe).  Corticosteroids and prophylactic antibiotics are not indicated. Fever is common following aspiration with pneumonitis – antibiotics should be withheld until there is objective evidence of bacterial infection

    2. Decontamination 
    Charcoal is contraindicated due to risk of aspiration.

    Ongoing care and monitoring

    Asymptomatic children with significant exposure and normal vital signs, including GCS, should be observed for 4 hours post exposure before discharge.

    Symptomatic patients should be admitted for a longer period of observation +/- supportive care.

    Enhance elimination – ineffective
    Antidote – Nil

    When to admit/consult local paediatric team, or who/when to phone:

    Mental health assessment and admission should be considered for all adolescent patients with an intentional overdose.

    Symptomatic patients should be admitted for a longer period of observation +/- supportive care.

    Consult Contact Victorian Poisons Information Centre 131126 for advice

    When to consider transfer to a tertiary centre:

    Patients with significant CNS depression / seizures or respiratory compromise who should be managed in a paediatric intensive care unit.

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Discharge Criteria:

    Normal GCS
    No Respiratory Symptoms
    Period of observation as above
    For deliberate ingestion a risk assessment should indicate that the patient is at low risk of further self harm in the discharge setting

    Discharge information and follow-up:

    Accidental ingestion: Parent information sheet from Victorian Poisons Information centre on the prevention of poisoning  

    Intentional self-harm: Referral to local mental health services e.g. Orygen Youth Health: 1800 888 320   

    Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685  

    Last updated June 2017