Tox: Household chemicals

Question 1

Mechanism of toxicity of caustics

Answer 1

1) Direct cellular injury
2) Acids: low pH causes coagulation necrosis. Eschar may help to prevent very deep injury.
3) Alkali/bases: high pH causes liquefactive necrosis resulting in slower, deeper penetrating injury.

Question 2

Factors that contribute to the degree of toxicity of caustics

Answer 2

pH, concentration, quantity ingested, titratable acid reserve, viscosity.

Question 3

Symptoms of caustic poisoning

Answer 3

Acute GI: burning sensation, vomiting, drooling, GIB, perforated viscus.
Acute pulm: airway burns if aspiration, upper airway edema, stridor, airway obstruction.
Dermal exposure: pain, chemical burn.
Ocular exposure: pain, lacrimation, hyperemia, chemosis, vision changes, globe rupture.
Delayed symptoms: GI scarring, strictures, obstruction.

Question 4

Signs of significant injury after pediatric unintential ingestion

Answer 4

Stridor, vomiting, drooling.

Question 5

Treatment of caustic ingestion/aspiration

Answer 5

1) ABC/supportive
2) Avoid vomiting, AVOID CHARCOAL, avoid lavage.
3) early intubation if airway involvement suspected.
4) Urgent GI consult for endoscopy if significant symptoms/ingestion (scope within 24 hrs or delay for 2 weeks). Helps to determine grade of injury and prognosis for risk of strictures.
5) Emergent surgical consultation for suspected perforation.

Question 6

Treatment of dermal exposure to caustic

Answer 6

Thorough irrigation, pain control, treat like any other burn.

Question 7

Tx of ocular caustic exposure

Answer 7

Decontaminate with large volume irrigation via morgan lens. Check pH 5 min after completing irrigation to ensure neutral. Consult optho.

Question 8

What is a hydrocarbon?

Answer 8

Any compound containing both hydrogen and carbon. Includes subcategories such as aliphatic (butane, octane, hexane), cyclic (cyclohexane), aromatic (benzene, toluene, naphthalene), halogenated (chloroform).

Question 9

Common sources of hydrocarbon exposure

Answer 9

Very common in household products including solvents, degreasers, fuels, oils.

Question 10

Mxn of hydrocarbon toxicity

Answer 10

Systemic: CNS depression, similar to anesthetic.
Toluene –> RTA and NAGMA.
Aspiration: chemical pneumonitis/ALI/ARDS, disruption of surfactant.

Question 11

Symptoms of hydrocarbon poisoning

Answer 11

CNS: AMS, intoxication, obtundation, coma, seizures.
GI: n/v
Pulmonary: aspiration pneumonitis, ALI/ARDS.
Cyclic variation: myocardial sensitization to catecholamines, leading to cardiac dysrhythmias after a patient is started (sudden sniffing death syndrome).

Chronic exposure: most common with abuse by huffing or inhalation. Results in leukoencephalopathy and slowed mentation.

Question 12

How is hydrocarbon toxicity treated?

Answer 12

1) ABCs, supportive
2) AVOID vomiting/charcoal/GL
3) Monitor for SS aspiration pneumonitis (cough, dyspnea, hypoxia, wheezing)- get CXR if persistent symptoms after 6 hrs
4) Admit any patient with persistent symptoms or evidence of aspiration on CXR

Question 13

Describe chlorine

Answer 13

Yellow-green gas, irritating odor, may be released from bleach (esp if in closed room or high concentration).

Question 14

What is chloramine

Answer 14

Irritating gas that is released from mixing ammonia and bleach.

Question 15

Mxn of toxicity of chlorine/chloramine

Answer 15

Cause direct mucus membrane irritation and inflammation.

Question 16

Symptoms of chlorine/chloramine toxicity

Answer 16

Pulmonary: MM irritation, wheezing, upper airway edema, stridor, pneumonitis, pulmonary edema (more common with chlorine gas)

Question 17

Tx of chlorine/chloramine toxicity

Answer 17

1) Remove from exposure to fresh air, consider warmed humidified air if available.
2) ABCs/supportive care.
3) Bronchodilators prn for significant wheezing, especially if history of asthma.
4) Observe pts for up to 24hrs if exposed to high concentration of chlorine gas