Pediatric emergency medicine trisk 3113 3113
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CLINICAL PEARLS
Hydrocarbon ingestion can cause severe aspiration pneumonitis, even
in the absence of vomiting.
Even asymptomatic patients should have a chest radiograph obtained
6 hours after ingestion to determine the need for further observation.
Current Evidence. Hydrocarbons are carbon compounds that become liquid at
room temperature. The term hydrocarbon is somewhat confusing and is often
used interchangeably with the term petroleum distillates. However, whereas all
petroleum distillates are hydrocarbons, not all hydrocarbons are petroleum
distillates (e.g., pine oil). Hydrocarbons can be found in solvents, fuels,
household cleaners, and polishes.
Hydrocarbons are typically divided into three categories: the aliphatic
hydrocarbons, the aromatics, and the “toxic” hydrocarbons. The aliphatic
hydrocarbons are petroleum distillates and are found in such household products
as furniture polish, lamp oils, and lighter fluids. The aromatic hydrocarbons are
cyclic structures and include toluene, xylene, and benzene. These agents are
found in solvents, glues, nail polish, paints, and paint removers. The “toxic”
hydrocarbons consist of a broad class of substances that possesses no specific
profile of toxicity. These agents include halogenated hydrocarbons and
hydrocarbons that serve as vehicles for toxic substances such as pesticides.
The major toxicity of hydrocarbons varies from class to class. However, they
all have in common low viscosity and surface tension that permits them to spread
freely over large surface areas. This property (plus their solvent actions) leads to a
necrotizing, potentially fatal chemical pneumonitis ( Fig. 102.9 ) when these
compounds are aspirated. The high volatility of these substances is responsible
for alterations in mental status, including narcosis, inebriation, and coma. In
addition to these toxicities, the solvents possess additional toxicities (see
“Inhalants” section), including the risk of bone marrow injury (in the case of
benzene). Finally, with the toxic hydrocarbons, additional toxicities may occur as
a result of actions such as cardiotoxicity or as a result of the pharmacologic
properties of the other agents contained within these compounds. The major
toxicity of hydrocarbons is classified in Table 102.15 .
The amount of ingested hydrocarbon is often difficult to quantify. However,
generally any degree of aspiration results in signs, including coughing, gagging,
or tachypnea. Less than 1 mL of some compounds, when aspirated directly into
