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Hydrocarbon Poisoning

by Gerald F. O’Malley, DO, Rika O’Malley, MD

Hydrocarbon poisoning may result from ingestion or inhalation. Ingestion, most common among children < 5 yr, can result in aspiration pneumonitis. Inhalation, most common among adolescents, can result in ventricular fibrillation, usually without warning symptoms. Diagnosis of pneumonitis is by clinical evaluation, chest x-ray, and oximetry. Gastric emptying is contraindicated because aspiration is a risk. Treatment is supportive.

Ingestion of hydrocarbons, such as petroleum distillates (eg, gasoline, kerosene, mineral oil, lamp oil, paint thinners), results in minimal systemic effects but can cause severe aspiration pneumonitis. Toxic potential mainly depends on viscosity, measured in Saybolt seconds universal (SSU). Hydrocarbon liquids with low viscosity (SSU < 60), such as gasoline and mineral oil, can spread rapidly over large surface areas and are more likely to cause aspiration pneumonitis than are hydrocarbons with SSU > 60, such as tar. Hydrocarbons, if ingested in large amounts, may be absorbed systemically and cause CNS or hepatic toxicity, which is more likely with halogenated hydrocarbons (eg, carbon tetrachloride, trichloroethylene).

Recreational inhalation of halogenated hydrocarbons (eg, glues, paint, solvents, cleaning sprays, gasoline, fluorocarbons used as refrigerants or propellants in aerosols—see Volatile Solvents), called huffing or bagging, is common among adolescents. It can cause euphoria and mental status changes and can sensitize the heart to endogenous catecholamines. Fatal ventricular arrhythmias may result; they usually occur without premonitory palpitations or other warning, often when patients are startled or chased.

Chronic toluene ingestion can cause long-term CNS toxicity, characterized by periventricular, occipital, and thalamic destruction.

Symptoms and Signs of Hydrocarbon Poisoning

After ingestion of even a very small amount of liquid hydrocarbon, patients initially cough, choke, and may vomit. Young children may have cyanosis, hold their breath, and cough persistently. Older children and adults may report burning in the stomach.

Aspiration pneumonitis causes hypoxia and respiratory distress. Symptoms and signs of pneumonitis may develop a few hours before infiltrates are visible on x-ray. Substantial systemic absorption, particularly of a halogenated hydrocarbon, may cause lethargy, coma, and seizures. Nonfatal pneumonitis usually resolves in about 1 wk; mineral or lamp oil ingestion usually resolves in 5 to 6 wk.

Arrhythmias usually occur before presentation and are unlikely to recur after presentation unless patients have excessive agitation.

Diagnosis of Hydrocarbon Poisoning

  • Chest x-ray and oximetry done about 6 h after ingestion

If patients are too obtunded to provide a history, hydrocarbon exposure may be suspected if their breath or clothing has an odor or if a container is found near them. Paint residue on the hands or around the mouth may suggest recent paint sniffing.

Diagnosis of aspiration pneumonitis is by symptoms and signs as well as by chest x-ray and oximetry, which are done about 6 h after ingestion or sooner if symptoms are severe. If respiratory failure is suspected, ABGs are measured.

CNS toxicity is diagnosed by neurologic examination and MRI.

Treatment of Hydrocarbon Poisoning

  • Supportive care

  • Avoidance of gastric emptying

Any contaminated clothing is removed, and the skin is washed. (C aution : Gastric emptying, which increases risk of aspiration, is contraindicated .) Charcoal is not recommended. Patients who do not have aspiration pneumonitis or other symptoms after 4 to 6 h are discharged. Patients who have symptoms are admitted and treated supportively; antibiotics and corticosteroids are not indicated.

Pearls & Pitfalls

  • Avoid gastric emptying if hydrocarbon ingestion is suspected (sometimes suspected based on odor of breath or clothing).

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