Hydrocarbon, caustic and household chemical exposure — formative SAQs

1. Decontamination decision

I would not give ipecac, would not perform gastric lavage, and would not give activated charcoal. Lamp oil is a very low-viscosity petroleum distillate whose dominant threat is aspiration pneumonitis rather than systemic absorption. Its low viscosity and low surface tension mean that a small aspirated volume spreads rapidly into the alveoli, disrupts surfactant and causes a chemical pneumonitis; inducing emesis or lavaging would provoke just such an aspiration and convert a contained exposure into a worse one. Activated charcoal does not adsorb hydrocarbons. [8]

2. Observation and chest X-ray

I observe the child for six hours, monitoring the respiratory rate, the work of breathing and the oxygen saturation throughout. I take a chest X-ray now as a baseline and repeat it if he becomes symptomatic; if he remains well, a film at the end of the observation period is taken at the discretion of the local protocol. I am aware that radiographic changes can lag behind symptoms by hours, so a normal early film does not exclude evolving pneumonitis. I call the poisons information centre with the product in hand to confirm the observation period. [8] [9]

3. Discharge criteria and safety net

I discharge at six hours if he is asymptomatic, with an oxygen saturation at or above his baseline on air, no increased work of breathing, and a normal or unchanged chest X-ray. I give a clear safety net: return immediately if cough, breathlessness, fever or drowsiness develop, and apply poison-prevention advice on safe storage. I confirm there is no safeguarding concern. [8]

4. Management of deterioration at four hours

Tachypnoea and hypoxaemia at four hours signal evolving hydrocarbon pneumonitis, so I admit him and begin supportive respiratory care with supplemental oxygen, escalating to high-flow nasal therapy, non-invasive or invasive ventilation as his work of breathing and saturation demand, with intensive care involvement for respiratory failure. I do not give corticosteroids or prophylactic antibiotics as routine, because the early illness is a chemical rather than an infective pneumonitis and these agents do not improve outcome; I treat proven secondary bacterial infection on its merits. In refractory acute respiratory distress syndrome I arrange specialist retrieval and consider surfactant and extracorporeal membrane oxygenation. [8] [9]