Hydrocarbon poisoning


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

  • See also:

    Key Points

    1. CNS, respiratory and cardiac effects are of main concern
    2. Activated charcoal is contraindicated in hydrocarbon poisoning
    3. Inhalation injury may manifest up to 6 hrs after exposure
    4. Ingestion of less than 5ml of pure essential oil can lead to significant CNS toxicity in children

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

    Background

    • Hydrocarbons can cause rapid onset of CNS symptoms including CNS depression and seizures.
    • Volatile hydrocarbons can be aspirated and cause chemical pneumonitis.
    • Cardiac dysrhythmias are less common
    • Poisoning can occur from accidental exposure (often younger children) or deliberate exposure (often from inhalation e.g. from “sniffing” or “chroming”)

    Sources:

      • Petrol
      • Kerosene
      • Lighter Fluid
      • Paraffin Oil
      • 2 Stroke Fuel
      • Diesel Fuel
      • Solvents
      • White Spirit
      • Lubricating Oil
      • Furniture Polishes
      • Essential oils
      • Mineral Turpentine

    Patients requiring assessment

    • All patients with deliberate self-poisoning or significant accidental exposure
    • Any symptomatic patient
    • Any patient whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.

    Risk Assessment

    History:
    Was exposure intentional or accidental?
    Dose:
    Type of compound
    Quantity ingested
    Duration of exposure in inhalation
    Co-ingestants (eg paracetamol)

    Examination:
    Respiratory:

    • Coughing / gagging / choking indicates aspiration
    • Wheeze, tachypnoea, hypoxia, haemoptysis and pulmonary oedema are signs of evolving chemical pneumonitis.

    Cardiovascular:

    • Dysrhythmias occur early in exposure

    CNS:

    • CNS depression, coma and seizures may occur with large acute exposures. Onset is usually within 2 hours

    GIT:

    • Nausea, vomiting and diarrhoea
    • Excessive burping, heartburn, epigastric pain

    Investigations:

    Asymptomatic children with small ingestions do not usually require investigation.

    For children with more significant ingestions, or who are symptomatic:

    • 12 lead ECG & cardiac monitoring for 4 hours
    • FBE, UEC, LFTs, VBG
    • CXR if respiratory symptoms

    For all children with deliberate poisoning, perform further screening for co-ingestants (See Acute poisoning - guidelines for initial management):

    • BSL
    • Paracetamol level

    Acute Management

    1. Resuscitation
    Standard procedures and supportive care

    • Intubate early for progressive CNS depression
    • Ventricular dysrhythmias:
      • Commence advance life support ( Resuscitation CPG)
      • Intubate, hyperventilate, correct hypoxia
      • Correct electrolyte disturbances
      • Withhold catecholamine inotropes if possible

     

    • 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
    Activated charcoal is specifically contraindicated in hydrocarbon poisoning as they do not bind hydrocarbons and increase the risk of hydrocarbon aspiration

    Ongoing care and monitoring
    Asymptomatic children with normal vital signs should be observed for 6 hours post exposure before discharge
    Patients with milder respiratory or CNS symptoms should be admitted for a longer period of observation +/- supportive care

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

    Admission should be considered for all adolescent patients with an intentional overdose.

    Consult Contact Victorian Poisons Information Centre 131126 for advice

    When to consider transfer to a tertiary centre:

    Patients with CNS depression / seizures or dysrhythmia 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  
    Normal ECG
    No respiratory symptoms (cough, dyspnoea, wheeze)
    Normal observations including pulse oximetry
    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 eg 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