- William J Lewander, MD
William J Lewander, MD
- Professor of Emergency Medicine and Pediatrics
- Brown University
- Alfred Aleguas, Jr, BS Pharm, PharmD, DABAT, FAACT
Alfred Aleguas, Jr, BS Pharm, PharmD, DABAT, FAACT
- Assistant Professor of Pharmacotherapeutics and Clinical Research
- University of South Florida
- Assistant Clinical Professor of Pharmacy
- University of Florida
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss hydrocarbon poisoning. Inhalant abuse in children and adolescents is discussed separately. (See "Inhalant abuse in children and adolescents".)
Hydrocarbon ingestion accounts for one to two percent of non-pharmaceutical exposures in children younger than six years of age reported to United States poison control centers . Although rare, hydrocarbon aspiration may cause death secondary to respiratory failure. Hydrocarbons were implicated in almost 5 percent of all single substance fatalities in this pediatric population . Gasoline, chlorofluorocarbon propellants, motor oils, lighter fluid/naphtha, lamp oil, and mineral spirits, are the most commonly ingested substances . In young children, the ingestion typically occurs as a result of exploratory behavior. Frequently, the hydrocarbon is unsecured or improperly stored in a drinking container (eg, soda bottle). Moderate or major toxic effects are associated most commonly with ingestions of lamp oil, kerosene, lighter fluid, and/or naphtha [2,3]. Toxicity in adolescents often arises from inhalant abuse of hydrocarbons. (See "Inhalant abuse in children and adolescents".)
Product safety — Since 2001, the United States consumer product safety commission has required child-resistant packaging for products that have low viscosity and contain ≥10 percent hydrocarbon by weight (table 1) . In 1997, the European Union attempted to minimize lamp oil aspiration by setting standards for viscosity and surface tension, the main determinants of aspiration risk. A follow-up study in 2005 showed no effect on number or severity of hydrocarbon aspiration in the years since the directive .
CLASSES OF HYDROCARBONS
The four structural classes of hydrocarbons are:
- Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila) 2010; 48:979.
- Jolliff HA, Fletcher E, Roberts KJ, et al. Pediatric hydrocarbon-related injuries in the United States: 2000-2009. Pediatrics 2013; 131:1139.
- Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila) 2014; 52:1032.
- Barone S. Child-resistant packaging. Consumer product safety review 2002; 6:3. www.cpsc.gov/cpscpub/pubs/cpsr_nws23.pdf (Accessed on August 05, 2009).
- Van Gorcum TF, Hunault CC, Van Zoelen GA, et al. Lamp oil poisoning: did the European guideline reduce the number and severity of intoxications? Clin Toxicol (Phila) 2009; 47:29.
- Lewander WJ, Aleguas A. Petroleum distillates and plant hydrocarbons. In: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, 4th, Shannon MW, Borron SW, Burns MJ (Eds), Saunders Elsevier, Philadelphia 2007. p.1343.
- Tormoehlen LM, Tekulve KJ, Nañagas KA. Hydrocarbon toxicity: A review. Clin Toxicol (Phila) 2014; 52:479.
- Gummin DD, Hryorzuk DO. Hydrocarbons. In: Goldfrank's Toxicologic Emergencies, 8th, Flomenbaum NE, Goldfrank LR, Hoffman RS, et al (Eds), McGraw-Hill, New York 2006. p.1429.
- Khine H, Weiss D, Graber N, et al. A cluster of children with seizures caused by camphor poisoning. Pediatrics 2009; 123:1269.
- Welker JA, Zaloga GP. Pine oil ingestion: a common cause of poisoning. Chest 1999; 116:1822.
- Dinwiddie SH. Abuse of inhalants: a review. Addiction 1994; 89:925.
- McHugh MJ. The abuse of volatile substances. Pediatr Clin North Am 1987; 34:333.
- Gurwitz D, Kattan M, Levison H, Culham JA. Pulmonary function abnormalities in asymptomatic children after hydrocarbon pneumonitis. Pediatrics 1978; 62:789.
- Ellenhorn MJ. The hydrocarbon products. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, 2nd, Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger (Eds), Williams & Wilkins, Baltimore 1997. p.1420.
- Prasad R, Karmakar S, Sodhi R, Karmakar S. Bilateral hemorrhagic pleural effusion due to kerosene aspiration. Lung India 2011; 28:130.
- Bergeson PS, Hales SW, Lustgarten MD, Lipow HW. Pneumatoceles following hydrocarbon ingestion. Report of three cases and review of the literature. Am J Dis Child 1975; 129:49.
- Thalhammer GH, Eber E, Zach MS. Pneumonitis and pneumatoceles following accidental hydrocarbon aspiration in children. Wien Klin Wochenschr 2005; 117:150.
- Wolfsdorf J, Paed D. Kerosene intoxication: an experimental approach to the etiology of the CNS manifestations in primates. J Pediatr 1976; 88:1037.
- Food and Drug Administration. Poison control case report summary-calendar year 1982. Rockville, MD 1984.
- Banner W Jr, Walson PD. Systemic toxicity following gasoline aspiration. Am J Emerg Med 1983; 1:292.
- Anas N, Namasonthi V, Ginsburg CM. Criteria for hospitalizing children who have ingested products containing hydrocarbons. JAMA 1981; 246:840.
- Arena JM. Hydrocarbon poisoning--current management. Pediatr Ann 1987; 16:879.
- Shannon M. Ingestion of toxic substances by children. N Engl J Med 2000; 342:186.
- Vale JA, Kulig K, American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: gastric lavage. J Toxicol Clin Toxicol 2004; 42:933.
- Benson BE, Hoppu K, Troutman WG, et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila) 2013; 51:140.
- Zucker AR, Berger S, Wood LD. Management of kerosene-induced pulmonary injury. Crit Care Med 1986; 14:303.
- Scalzo AJ, Weber TR, Jaeger RW, et al. Extracorporeal membrane oxygenation for hydrocarbon aspiration. Am J Dis Child 1990; 144:867.
- Liebelt EL, DeAngelis CD. Evolving trends and treatment advances in pediatric poisoning. JAMA 1999; 282:1113.
- Bysani GK, Rucoba RJ, Noah ZL. Treatment of hydrocarbon pneumonitis. High frequency jet ventilation as an alternative to extracorporeal membrane oxygenation. Chest 1994; 106:300.
- Chyka PA. Benefits of extracorporeal membrane oxygenation for hydrocarbon pneumonitis. J Toxicol Clin Toxicol 1996; 34:357.
- Mabe TG, Honeycutt T, Cairns BA, et al. High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration. Pediatr Crit Care Med 2007; 8:383.
- Lee, LK, Shannon, MS, Arnold, JH. The use of high frequency oscillatory ventilation in hydrocarbon pneumonitis. Int J Med Toxicol 2003; 6:10.
- Marks MI, Chicoine L, Legere G, Hillman E. Adrenocorticosteroid treatment of hydrocarbon pneumonia in children--a cooperative study. J Pediatr 1972; 81:366.
- Steele RW, Conklin RH, Mark HM. Corticosteroids and antibiotics for the treatment of fulminant hydrocarbon aspiration. JAMA 1972; 219:1434.
- Karlson KH Jr. Hydrocarbon poisoning in children. South Med J 1982; 75:839.
- Klein BL, Simon JE. Hydrocarbon poisonings. Pediatr Clin North Am 1986; 33:411.
- Product safety
- CLASSES OF HYDROCARBONS
- HYDROCARBON TOXICITY
- Determinants of pulmonary aspiration
- Acute systemic toxicity
- CLINICAL MANIFESTATIONS
- Initial presentation and diagnosis
- Physical findings after hydrocarbon exposure
- - Vital signs
- - Respiratory
- - Central nervous system
- - Cardiovascular
- - Gastrointestinal
- - Hematologic
- Ancillary studies
- - Radiographic findings
- DIFFERENTIAL DIAGNOSIS
- External decontamination
- Gastrointestinal decontamination
- - Systemic toxicity likely
- Pulmonary management
- ADDITIONAL RESOURCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS