Kerosene poisoning

This seminar is introduced by:

AbdulAziz Zidan

Ibraheem Atallah

Ahmed Moayad

Supervised by: Dr.Farah

Clinical presentation

Respiratory : Chocking, gagging, and coughing usually begins immediately or within 2-5 min of aspiration and persists.

Oral pain may occur in irritating hydrocarbons ingestion.

Vomiting is common and it may increase the risk of aspiration but not necessary for it.

In most children, the initial symptoms resolve without develpment of aspiration pneumonitis.

Signs of significant exposure

Continued cough

Tachypnoea

Increased respiratory effort

Rib cage retractions

Grunting

wheezes

Radiographic findings

Often occur before the development of physical findings.

They may be seen within 20 minutes or as late as 24 hour after aspiration.

CXR abnormalities typically peak between 2-4 hours after aspiration.

The resolution of radiographic changes is gradual and lags behind clinical improvement, which usually occurs 3-5 days after aspiration.

Chest X-Ray findings are hetrogenous and may include perihilar, basal, or lobar densities.

These findings can be found in asymptomatic patients.

Early X-Ray within few hours shows increased bronchovascular markings.

After six days shows marked consolidation.

Another patient presented at the eighth day with Rt.sided hydrorpneumothorax.

Decreased Rt.sided hydropneumothorax with drainage tube in situ.

Occasionally, pneumatoceles develop after several days and may take weeks to resolve.

CVS:

Cardiac arrhythmia may occur after inhalation.

Solvent hydrocarbons can sensitize the myocardium to catecholamines.

GIT:

Ingestion of aliphatic hydrocarbons causes direct local irritation to the pharynx, oesophagus, stomach, and small intestine, with oedema and mucosal ulceration, and it may be associated with nausea and haematemesis.

These effects are usually mild and rarely require treatment.

CNS:

HC ingestion or inhalation may have direct CNS effects as somnolence, headache, ataxia, dizziness, blurred vision, weakness, fatigue, lethargy, stupor, seizure, and coma.

In addition hypoxia caused by HC aspiration may cause 2ry CNS depression including, drowsiness, tremor, or convulsions.

Haematologic:

Leukocytosis with fever occurs early in the clinical course of HC aspiration, unrelated to pneumonitis and may last as long as one week.

Haemolysis, haemoglobinuria, and consumptive coagulopathy also may occur with significant ingestion.

Management

Treatment is usually supportive, with attention to respiratory and CNS symptoms.

Observe in ER for 6-8 hours if no symptoms=Discharge

Do not induce vomiting.

Do not attempt gastric lavage.

If gastric lavage is to be performed, the patient should be intubated with a cuffed ETT to protect airways.

Bronchospasm should be treated with selective beta 2 agonists.

Avoid epinephrine and isoproterenol??

Corticosteroid should be avoided.

Antibiotics are given if bacterial pneumonia occurs.

Prevention

Household kerosene should be kept away from children’s reach.

The word ‘poison’ should be exhibited prominently on the containers of kerosene.

Kerosene oil should not be stored in tumblers or beverage bottles.

Please..

Thanks..