Hydrocarbon toxicity: Difference between revisions

Revision as of 04:24, 30 August 2015

Typical exposures:
- Unintentional exposure (generally young children)
- Intentional abuse (generally adolescents, young adults)
- Occupational exposure - dermal, inhalation
Intentional abuse methods:
- Huffing= hydrocarbon soaked into rag and placed over mouth and nose
- Bagging= hydrocarbon placed in a bag and fumes inhaled
- Sniffing= hydrocarbon inhaled directly
High volatility, low viscosity → high risk for aspiration despite "simple ingestion"

Pulmonary: aspiration
- Risk factors: high volume, vomiting, gagging, choking, coughing
- CXR on presentation nonpredictive, but usually appear by 6hrs

Cardiac: arrhythmias, Afib, PVCs, Vtach, torsades
"Sudden sniffing death syndrome"= suspected cardiac sensitization to catecholamines
- Classic scenario: Sniffer is startled during use, collapses and dies
CNS/PNS: excitation, followed by depression, ataxia, neuropathy

CXR: immediately if symptomatic, otherwise early CXR not predictive of pneumonitis. Observe for 4-6hrs then obtain CXR
Labs: as needed to evaluate for acidosis, anemia, renal/hepatic toxicity, coagulation, methemoglobinemia, carboxyhemoglobinemia depending on specific exposure
ECG

Pulmonary

Secure airway, if needed.
Beta2 agonist if wheezing (not proven benefit), consider Bipap/Cpap (may further barotrauma)
Severe toxicity will need intubation, high PEEP, possibly high frequency jet ventilation, and ECMO for refractory hypoxemia
Antibiotic prophylaxis show no benefit, but use if superinfection present
Steroids not recommended for chemical pneumonitis and can lead to increased superinfection

Cardiovascular

Dermal

GI

Authors:

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 ==Differential Diagnosis==
+{{Drugs of abuse types}}
 ==Diagnosis==