Kerosene ingestion

Introduction:

Kerosene is a distillate of petroleum. It is a common house hold fuel. It is also used as a diluent for insecticides / pesticides. It is hence commonly stored item in every house hold. Children especially toddlers are more prone for kerosene poisoning. Major risks of kerosene poisoning include:

1. Pulmonary complications (due to aspiration)

2. Neurological complications

Presence of cough, cyanosis and shallow rapid breathing in a child with history of kerosene poisoning would indicate aspiration of kersoine into the lungs. This is usually associated with chemical pneumonitis, or secondary bacterial infection.

CNS disorders are manifested by drowsiness, irritability stupor / coma and occasionally convulsions.

Chemistry of Kerosene:

It is a hydrocarbon complex derived from petroleum. It contains varying proportions of paraffins and naphthenes. The toxicity of kerosene depends on its contents of naphthenic and aromatic hydrocarbons. These could vary in type and proportion with the place or origin of the crude oil.

Studies reveal that pneumonitis could follow gastro-intestinal absorption and is considered to be of greater importance than aspiration into the lungs. Experiments suggest that a 20 kg child will have to ingest more than 600 ml of kerosene for it to develop pneumonitis. Pneumonia could be the result of aspiration and absorption from GI tract. Hence gastric lavage is advisable in all these patients as a precaution. There are instances where aggressive gastric lavage causing aspiration.

Clinical features:

These are mostly due to pneumonitis. Pulmonary changes are usually bilateral in nature. Chest radiographs reveal the presence of pneumonitis.

CNS complications include drowsiness, coma and convulsions.

Management:

Airway stabilization is the first priority in all these patients. Supplementary oxygen and oxygen saturation monitoring should be performed. In patients with inadequate oxygenation, early intubation with ventilatory support could help. Gastric lavage should be performed if the ingested amount is more than 100 ml. Lavage should be performed with atmost care as there is always the impending risk of aspiration.

Anti emetics need to be administered to prevent vomiting as this could easily aspirate into the airway.

Bronchodilators and steroids can be considered if these children have bronchospasm.

Patients may be discharged if the following parameters are met:

1. The patient has been observed in the emergency department for at least 6 hours

2. Asymptomatic patients

3. Chest radiographs are normal

4. These patients should live close by and should return to the hospital if cough / breathlessness develop.