ABCs: Stabilization of the airway is always the first priority of treatment in patients with hydrocarbon poisoning.

Give supplemental
oxygen to all patients, and perform beside pulse oximetry. Early intubation, mechanical ventilation, and use of positive end-expiratory
pressure may be warranted in a patient in whom oxygenation is inadequate or in a patient who has severe respiratory distress or a
decreased level of consciousness. Take all precautions to minimize the patient's risk of vomiting and further aspiration. A trial of
bronchodilators may prove useful in patients with suspected bronchospasm.
Cutaneous decontamination in cases of cutaneous exposure: Decontaminate the skin as soon as possible by removing the
involved clothing and thoroughly washing the skin with soap and water. Vapor inhalation and cutaneous absorption may occur long after the
exposure. Health care providers must take precautionary action to minimize their own exposure to the toxic substance.
Gastric decontamination in cases of oral ingestion
Gastric decontamination is controversial. If gastric decontamination is considered, the airway must be stabilized to
minimize the risk of aspiration secondary to the patient's vomiting.
Because a major complication of hydrocarbon ingestion is aspiration, reserve the use of gastric decontamination for
only cases of large intentional ingestions or those involving an increased risk of systemic toxicity.
Gastric decontamination includes the induction of emesis by administering ipecac syrup and then gastric lavage.
The use of ipecac syrup is rarely indicated to induce emesis; exceptions involve situations in which the
patient's mental status is within normal limits and in which a large volume of a known toxic substance has been ingested. Never induce
emesis after the ingestion of a low-viscosity hydrocarbon (eg, gasoline, kerosene, furniture polish, mineral spirits) because the aspiration
risk is high. The induction of emesis is rarely indicated in children because they usually do not ingest a large volume.
Regarding gastric lavage, the risk and complications of aspiration outweigh the benefits. If lavage is
attempted, nasogastric lavage is advised because the ingested substance is a liquid, and the use of a large-caliber orogastric tube greatly
increases the risk of vomiting and aspiration. Lavage is useful in cases in which the hydrocarbon has an inherent systemic toxicity or
contains additives with known toxicity.
A useful mnemonic for remembering such hydrocarbons is CHAMP, which stands for the following: camphor,
halogenated hydrocarbons, aromatic hydrocarbons, (heavy) metal-containing hydrocarbons, and pesticide-containing hydrocarbons.
Activated charcoal has a limited role in the management of hydrocarbon ingestion. Charcoal poorly adsorbs
most hydrocarbons. Furthermore, charcoal tends to distend the stomach and cause vomiting, increasing the aspiration potential. The use
of activated charcoal is indicated in cases of a suicide attempt or in cases in which another adsorbable toxic substance have been coingested.

MANAGEMENT
Because hydrocarbons are a diverse family of compounds with a wide spectrum
of toxicities identification of the specific type, route, and amount of hydrocarbon
exposure is essential to effective management.
Decontamination of the skin should have high priority in massive hydrocarbon
exposures, particularly those exposures involving highly toxic hydrocarbons.
Water may be ineffective to decontaminate most hydrocarbons, but
early decontamination with soap and water may be adequate. Gastric decontamination
is of no benefit and potentially detrimental following ingestion of
a hydrocarbon where the primary toxicity is expected to be pulmonary. However
when severe systemic toxicity is expected as may be the case when the
hydrocarbon is used to solubilize a potent xenobiotic, gastric emptying should
be considered (Table 1024). Activated charcoal (AC) has limited ability to
decrease gastrointestinal absorption of hydrocarbons and may distend the
stomach and predispose patients to vomiting and aspiration. The use of AC is
only justified in patients with significant mixed overdoses.
Abnormal lung auscultation, fever, leukocytosis, and abnormal radiographic
findings are the initial manifestations of both bacterial pneumonia
and hydrocarbon pneumonitis. Decisions regarding antibiotic use are complex.
As a result, antibiotics are frequently administered in the setting of hydrocarbon
pneumonitis, despite the absence of experimental evidence of benefit.
Ideally, sputum cultures should direct antibiotic use. Similarly, animal
models and two controlled human trials failed to show a benefit from corticosteroid
administration. Likewise, no evidence supports routine administration
of surfactant.
Respiratory distress requiring mechanical ventilation may be associated
with a large ventilationperfusion mismatch. The use of positive end-expiratory
pressure (PEEP) in this setting is often beneficial. However, very high
levels of PEEP may be required with subsequent increased risk of barotrauma.
Extracorporeal membrane oxygenation (ECMO) appears beneficial when
more tradition means of oxygenation fail.
TABLE 1024. Gastric Emptying for Hydrocarbon Ingestion
Contraindications
Occurrence of spontaneous vomiting

 Asymptomatic initially and at initial medical evaluation

Indications
A hydrocarbon with inherent systemic toxicity (CHAMP)
C: camphor
H: halogenated hydrocarbons
A: aromatic hydrocarbons
M: hydrocarbons containing metals
P: hydrocarbons containing pesticides

803
Management of dysrhythmias associated with hydrocarbon toxicity should
include consideration of electrolyte and acidbase abnormalities (eg, hypokalemia
and acidosis from toluene), hypoxemia, hypotension, and hypothermia.
Ventricular fibrillation poses a specific concern, as common resuscitation algorithms
recommend epinephrine administration to treat this rhythm. If it is
ascertained that the dysrhythmia emanates from myocardial sensitization by a
hydrocarbon solvent, catecholamines should be avoided. In this setting, lidocaine
has been used successfully, as has _-adrenergic antagonism.
In the past, hospital admission was routinely recommended for patients
who had ingested hydrocarbons, because of the concern over possible delayed
symptom onset and progression of toxicity. Current evidence suggests
that a patient who is asymptomatic after a 6-hour observation period and who
has a normal 6-hour chest radiograph is at an exceedingly low risk of consequential
deterioration. Those patients who have clinical evidence of toxicity
and most individuals with intentional ingestions should be hospitalized. Care
should be individualized for patients who are asymp
102 HYDROCARBONS