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Hydrocarbons are a diverse group of organic compounds consisting primarily of carbon and hydrogen atoms. The two basic forms of hydrocarbons are aliphatic (straight- or branched-chain carbon arrangement) or aromatic (carbon arranged in a ring). Hydrocarbons are in many household and occupational products (Table 199-1). While all hydrocarbons can be toxic, aromatic and halogenated hydrocarbons are associated with the most severe systemic toxicity. Volatile agents are associated with the highest aspiration risk. Identification of the specific hydrocarbon or class can help anticipate specific potential toxicity and guide management.
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Chain length and branching determine the phase of the hydrocarbon at room temperature. Short-chain aliphatic compounds (up to 4 carbons), such as methane, ethane, propane, and butane, are gases; intermediate-chain aliphatic compounds (5 to 19 carbons), such as solvents, lamp oil, lighter fluid, and gasoline, are liquid; and long-chain aliphatic compounds (>19 carbons), such as waxes, are solids. Liquid hydrocarbons account for most exposures seen in the ED.1
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Most hydrocarbon exposures occur as liquid ingestions or inhalations and usually have a benign clinical course.1,2 Serious toxicity and deaths associated with hydrocarbon exposure are usually due to ingestions rather than inhalation. Symptoms and signs of pulmonary injury develop in up to 50% of the children who ingest hydrocarbons,3,4 and hydrocarbon aspiration can produce acute respiratory distress syndrome.5 Suicidal injection of gasoline or kerosene with severe multiorgan toxicity has been reported.6,7
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Volatile substances, usually hydrocarbon solvents contained in household or commercial products, can be inhaled for their euphoric effects (Table 199-2...