Ver el código de «Hydrocarbon toxicity»

==Background==
*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"
*Easily washes out pulmonary surfactant if aspirated

===Examples===
*Gasoline
*Lighter fluid
*Lamp oil
*Petroleum jelly (Vaseline)
*Paint
*Paint thinners
*Polish
*Toluene

==Clinical Features==
===Pulmonary===
*Aspiration
**Low viscosity and surface tension of hydrocarbons make them high aspiration risk
**Additional risk factors: high volume, vomiting, gagging, choking, coughing
**[[CXR]] on presentation nonpredictive, but usually appear by 6hrs
*[[ARDS]]

===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 <ref> Tormoehlen L et al. Hydrocarbon toxicity: A review. Clinical toxicology 2014; 52: 479-489 </ref>===
*Stage 1: [[headache]], [[dizziness]], [[nausea]], tinnitus
*Stage 2: Slurred speech, confusion, [[hallucinations]], [[diplopia]], [[ataxia]]
*Stage 3: Obtundation, [[seizure]], death

===Renal===
*Toluene in particular may cause weakness secondary to severe [[hypokalemia]]

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

{{Toxic gas exposure DDX}}

==Evaluation==
===Workup===
*[[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]]

===Evaluation===
*Clinical diagnosis, based on history and physical exam

==Management==
===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===
*Treat hypotension with aggressive [[IVF]]
*Avoid [[dopamine]], [[epinephrine]], [[norepinephrine]] (may cause [[dysrhythmias]]), [[procainamide]] (may cause [[arrhythmias]]), and [[amiodarone]] ([[QT prolongation]])
*Treat ventricular dysrhythmias with [[propranolol]], [[esmolol]], or [[lidocaine]]
**Due to overstimulation of beta receptors by hydrocarbon

===Dermal===
*Pre-arrival decontamination, remove clothing
*Soap and water, saline for eye exposure

===GI===
*[[GI decontamination]] controversial
*Majority do not benefit

==Disposition==
===Discharge===
After 6 hour observation if:
*Asymptomatic
*Normal vital signs (including SpO2)
*No abnormal pulmonary findings
*Normal CXR at 6hrs post exposure
**If asymptomatic but radiographic evidence of pneumonitis, consider discharge with 24-hour follow-up.

===Admit===
*Clinical evidence of toxicity

==See Also==
*[[Toxicology (Main)]]
*[[Inhalants]]

==References==
<references/>


[[Category:Toxicology]]