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INTRODUCTION

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Products containing hydrocarbons are found in many household and workplace settings and include fuels, lighter fluids, paint removers, pesticides, polishers, degreasers, and lubricants. Some volatile substances may be recreationally abused. Exposure may cause mild to severe toxicity and, rarely, sudden death.

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CLINICAL FEATURES

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Toxicity depends on route of exposure, physical characteristics, chemical characteristics, and the presence of toxic additives (e.g., lead or pesticides). See Table 111-1 for clinical features.

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Table 111-1

Clinical Manifestations of Hydrocarbon Exposure

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Chemical pneumonitis is the most common pulmonary complication and is most likely to occur following aspiration of a hydrocarbon with low viscosity (ability to resist flow), high volatility (tendency for a liquid to become a gas), and low surface tension (cohesive force between molecules). Symptoms occur quickly and include cough, gagging, choking, and dyspnea. Physical examination may reveal tachypnea, wheezing, grunting, and an elevated temperature. Radiographic abnormalities do not always occur. If radiographic findings occur, they may lag behind the clinical picture by 4 to 24 hours, but most are apparent within 6 hours.

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Cardiac toxicity manifests as potentially lethal dysrhythmias resulting from myocardial sensitization to circulating catecholamines (“sudden sniffing death syndrome”). Halogenated hydrocarbon solvents are most frequently implicated, but all classes of hydrocarbons have been associated with dysrhythmias.

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Central nervous system toxicity may present as intoxication, ranging from initial giddiness, agitation, and hallucinations to seizures, slurred speech, ataxia, and coma. Chronic exposure may cause recurrent headaches, cerebellar ataxia, and mood lability.

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Gastrointestinal toxicity can include vomiting (which can lead to aspiration), abdominal pain, anorexia, and hepatic damage (particularly from halogenated hydrocarbons such as carbon tetrachloride, methylene chloride, trichloroethylene, and tetrachloroethylene).

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Dermal toxicity includes contact dermatitis and blistering with progression to full-thickness burns. Injection of hydrocarbons can cause tissue necrosis. Burns can result after cutaneous contact with hot tar and asphalt.

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Less common acute toxicities include hematologic disorders such as hemolysis, methemoglobinemia, carboxyhemoglobinemia (from methylene chloride), and renal dysfunction.

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DIAGNOSIS AND DIFFERENTIAL

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Diagnosis is made by history and physical examination findings, bedside monitoring, laboratory tests, and chest radiograph. An abdominal radiograph may reveal ingestion of ...

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