At many places kerosene is still the most common and cheap fuel available. Being mostly utilised in poor households we still come across cases of children accidentally drinking kerosene or adults deliberately doing so, causing kerosene poisoning.
Here, today we discuss kerosene poisoning and its consequences.
What is kerosene?
Kerosene is a fuel utilised in households and industry. Kerosene is a highly flammable liquid form of fuel. It is hydrocarbon derived from crude.
How does it cause poisoning?
Kerosene poisoning is caused when it is ingested and goes to the airway or ingested and goes to the stomach.
When gone into the airway it affects the respiratory tract causing pneumonitis and causing ARDS and death.
When ingested it goes to the stomach and causes gastrointestinal effects. If a patient vomits and it gains entry to the respiratory tract it affects the lungs.
How does kerosene poisoning affect humans?
Kerosene has very low surface tension and it spreads very rapidly over mucosal surfaces. Even a very small amount gaining entry into lungs can spread on the surface of bronchi and alveoli. It damages the surfactant layer of the respiratory tract.
When the surfactant layer is damaged in the lungs the lungs cannot remain inflated and they tend to collapse. It causes pneumonitis and inflammation of the bronchi and alveoli and complicates into acute respiratory distress syndrome (ARDS) and pneumonia it can cause death.
When the gastrointestinal tract is affected, as it passes further in the intestinal lumen it causes inflammation in the intestine. It can make the person suffer from severe gastrointestinal symptoms.
What are symptoms of kerosene poisoning?
This condition mainly affects young children as they can accidentally drink the kerosene by mistake.
The symptoms can appear in a few minutes to few hours usually 6 hours.
If the kerosene has gone into the intestinal tract it produces irritable inflammatory symptoms.
Abdominal pain: Abdominal pain that is mild or sometimes severe may appear in a few minutes to a few hours of ingesting kerosene.
Nausea and vomiting: Nausea and vomiting after ingesting kerosene is a major concern as a patient may inhale the kerosene while vomiting and kerosene going in lungs is really dangerous.
Loose motions: After sometime as the kerosene passes further in the lungs patients may start loose motions and get dehydrated with that. Some patients may develop electrolyte imbalance with ongoing dehydration.
Respiratory symptoms are most dangerous and may be life threatening. They can appear in a few hours after the kerosene gains entry into the lung.
The patient which appears stable initially may suddenly deteriorate and may suffer severe pneumonitis and ARDS.
Initially stable patients may suddenly need oxygen and may be ventilatory support.
Cough and difficulty in breathing or breathlessness may appear.
Patients may appear gasping for air and chest and abdomen may move vigorously while breathing.
With increasing difficulty in breathing there may be intercostal and subcostal retractions. If the condition deteriorates, the patient needs ventilatory support.
With difficulty in breathing the oxygen saturation of the blood may fall in a very short period of time.
What is treatment of kerosene poisoning?
Currently hydrocarbons and kerosene have no antidote. Preventing this condition by keeping these items out of reach of those vulnerable children is the best way of prevention.
Those with suspected kerosene poisoning should be admitted to a hospital where respiratory care is available at a centre where an ICU is available.
The treatment should be provided as per need and symptoms of the patient.
Given the possibility of dramatic deterioration in the condition of the patient, the person or the child who ingested kerosene should be admitted and monitored even when there are no symptoms for 1-2 days.
If no symptoms, a chest X-ray should be done after 6 hours.
Patients pulse, blood pressure, respiratory rate, oxygen saturation and general condition should be rigorously monitored. The needed care should be provided as per the condition of the patient.
Kerosene ingestion causes gastrointestinal symptoms causing vomiting and loose motion. Patient should be hydrated. Hydration should be given a parenteral route and stomach should be kept empty as there is a chance of vomiting and aspiration causing lung injury.
Respiratory symptoms of the patient need immediate attention and supplementary oxygenation.
If breathlessness is more patient needs ventilatory support to treat pneumonitis and ARDS.
There is no proven role of antibiotics in kerosene poisoning. Antibiotics will be useful if the pneumonitis is complicated by bacterial infection and pneumonia.
Currently there is no proven role of steroids in case of kerosene poisoning.
Emesis and stomach wash
Emesis and stomach wash may cause aspiration of stomach contents containing kerosene lungs.
So attempting emesis and stomach wash is contraindicated in hydrocarbon and kerosene poisoning.
Activated charcoal has a huge surface area and it can adsorb poisons on it thus reducing their absorption from the intestine into the blood.
Kerosene being a hydrocarbon does not get adsorbed on activated charcoal. Additionally activated charcoal can induce vomiting. Activated charcoal should not be used in case of the kerosene poisoning.