History

Fact Explanation
Symptoms due to respiratory tract involvement Cough, tachypnea and grunting are common. [1]
Symptoms due to central nervous system involvement Restlessness, confusion and coma are various presentations indicating central nervous system involvement. Other presentations are light headedness, dizziness, headache, seizures and visual disturbances. [1]
Symptoms due to gastrointestinal tract involvement Patient may complain of burning sensation of the mouth and throat immediately after ingestion. Nausea, vomiting, belching, abdominal pain and diarrhea or constipation are symptoms suggestive of gastrointestinal tract involvement. [1,4]
Fever In kerosene poisoning fever is a common symptom. Fever may persists for few days. Fever may be the presenting feature if the patient has developed pneumonitis after few days of kerosene ingestion. [1,2]
Smell of kerosene Often parents or caretakers of adults complain of smell of kerosene around the patient. [2]
Accidental poisoning Children and elderly patients are at risk of accidental ingestion. [1]
People who are at risk of deliberate selfharm People who have depression, anxiety, impulsivity and low self-esteem are at risk of suicide. Drug misuse, family members with attempts of deliberate selfharm also play a significant role. [3]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992
  2. HEURGREN G. Survey of toxicology information. Fundam Appl Toxicol [online] 1991 Jan, 16(1):210 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2019347
  3. HAWTON K.. Deliberate self harm in adolescents: self report survey in schools in England. [online] 2002 November, 325(7374):1207-1211 [viewed 15 June 2014] Available from: doi:10.1136/bmj.325.7374.1207
  4. UTPAL KANT SINGH, PRASAD R, GAURAV A. HYDROCARBON AND RELATED COMPOUNDS POISONING. Indian Journal of Practical Pediatrics. [online] 2009, 11(1): 15-21 [viewed 15 June 2014] Available from: http://www.ijpp.in/admin/uploadimage/Jan%20-%20Apr.pdf

Examination

Fact Explanation
Fever Patients with pneumonitis are often febrile. [2]
Cyanosis Due to respiratory tract involvement. [1]
Signs of pneumonitis Tachypnea, pulmonary crepitations and rhonchi are detected in pneumonitis. [1,2]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992
  2. HEURGREN G. Survey of toxicology information. Fundam Appl Toxicol [online] 1991 Jan, 16(1):210 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2019347

Differential Diagnoses

Fact Explanation
Adult respiratory distress syndrome Patients present with dyspnea and or cyanosis. Diffuse lung infiltrations and pulmonary edema are seen in the chest X-ray. [1]
Poisoning of other substances Alcohol intoxication, barbiturate overdose and benzodiazepine overdose may also lead to confusion, coma and sometimes seizures.
References
  1. PETTY TL, NEWMAN JH. Adult Respiratory Distress Syndrome West J Med [online] 1978 May, 128(5):399-407 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1238151
  2. STUKE L, DIAZ-ARRASTIA R, GENTILELLO LM, SHAFI S. Effect of Alcohol on Glasgow Coma Scale in Head-Injured Patients Ann Surg [online] 2007 Apr, 245(4):651-655 [viewed 15 June 2014] Available from: doi:10.1097/01.sla.0000250413.41265.d3

Investigations - for Diagnosis

Fact Explanation
Full blood count Leukocytosis is seen. [1]
Chest X-ray Lung consolidation and pleural effusions can be seen. Pneumothorax and pneumomediastinum are sometimes seen. [1]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992

Investigations - Fitness for Management

Fact Explanation
Lung function test In patients with severe respiratory tract involvement with chemical pneumonitis, a lung function test may be necessary. [1]
Arterial blood gas analysis Reflect the respiratory function and the extent of lung damage. [1]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992

Investigations - Followup

Fact Explanation
Chest X-ray Chemical pneumonitis can occur with kerosene ingestion. Usually these resolve with no residual effects. [1] Lower lobes are commonly affected. [2]
ECG Arrhythmia is a known complication of hydrocarbon poisoning. [2]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992
  2. HEURGREN G. Survey of toxicology information. Fundam Appl Toxicol [online] 1991 Jan, 16(1):210 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2019347

Management - General Measures

Fact Explanation
Health education Substances should be stored in a safe and closed place, out of reach of children. In a case of ingestion, clothes, if contaminated should be removed. Skin and hair should be washed thoroughly with soap and water. If poisoning is suspected patient should be transported to the nearest hospital immediately with the suspected hydrocarbon container in order to correctly identify the poison and to guide the treatment. [1]
Basic life support Patients airway, breathing and circulation should be assessed and managed accordingly. Patency of the airway should be established and oxygen should be given if necessary. [1]
Antiemetics Patients with vomiting should be treated with antiemetics, because emesis either spontaneous or induced is considered harmful, especially in kerosene poisoning. [1,2]
Antipyretics Effective in controling fever. [1]
Anticonvulsants Patients with seizures should be given anticonvulsants. [1]
Gastric lavage Gastric lavage is not routinely indicated in hydrocarbon poisoning because of the significant risk of aspiration and chemical pneumonitis. It is rarely practiced when the risk of systemic toxicity is more than the risk of aspiration. [3]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992
  2. JONES AL, VOLANS G. Management of self poisoning BMJ [online] 1999 Nov 27, 319(7222):1414-1417 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117144
  3. UTPAL KANT SINGH, PRASAD R, GAURAV A. HYDROCARBON AND RELATED COMPOUNDS POISONING. Indian Journal of Practical Pediatrics. [online] 2009, 11(1): 15-21 [viewed 15 June 2014] Available from: http://www.ijpp.in/admin/uploadimage/Jan%20-%20Apr.pdf

Management - Specific Treatments

Fact Explanation
Initial patient resuscitation Initial focus should be to assess and to optimize patient's airway, breathing and circulation. Airway should be kept patent in patients with impaired consciousness or coma. Oxygen should be administered in all hospital admitted patients via a face mask while monitoring the oxygen saturation. Patients with severe respiratory distress and hypoxia need early intubation and mechanical ventilation with positive end-expiratory pressure or with continuous positive airway pressure. In patients with vomiting a nasogastric tube will minimize the risk of aspiration. [1,2]
Management of arrhythmia Patients can develop cardiac arrhythmias secondary to hydrocarbon ingestion. Antiarrhythmic drugs or electrical defibrillation may be needed depending on the type of arrhythmia. ECG monitoring is necessary through out the treatment process. [3]
Antibiotic prophylaxis against aspiration pneumonia This is not routinely indicated. In the presence of symptoms and signs of acute infection antibiotic prophylaxis is indicated. [2,5]
surfactant therapy Surfactant therapy is useful in minimizing the lung injury. [4]
References
  1. NAGI NA, ABDULALLAH ZA. Kerosene poisoning in children in Iraq. Postgrad Med J [online] 1995 Jul, 71(837):419-422 [viewed 15 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397992
  2. UTPAL KANT SINGH, PRASAD R, GAURAV A. HYDROCARBON AND RELATED COMPOUNDS POISONING. Indian Journal of Practical Pediatrics. [online] 2009, 11(1): 15-21 [viewed 15 June 2014] Available from: http://www.ijpp.in/admin/uploadimage/Jan%20-%20Apr.pdf
  3. MARTINEZ M. A., BALLESTEROS S.. Investigation of Fatalities Due to Acute Gasoline Poisoning. Journal of Analytical Toxicology [online] 2005 October, 29(7):643-651 [viewed 15 June 2014] Available from: doi:10.1093/jat/29.7.643
  4. MASTROPIETRO C. W., VALENTINE K.. Early Administration of Intratracheal Surfactant (Calfactant) After Hydrocarbon Aspiration. PEDIATRICS [online] December, 127(6):e1600-e1604 [viewed 16 June 2014] Available from: doi:10.1542/peds.2010-3229
  5. PRASAD R, KARMAKAR S, SODHI R, KARMAKAR S. Bilateral hemorrhagic pleural effusion due to kerosene aspiration Lung India [online] 2011, 28(2):130-132 [viewed 16 June 2014] Available from: doi:10.4103/0970-2113.80329