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Toxicity of hydrocarbons
• Hydrocarbons are a heterogenous group of organic
substances that are primarily composed of carbon and
hydrogen molecules...
• Hydrocarbons can be classified as being
aliphatic, in which the carbon moieties are
arranged in a linear or branched cha...
• Toxicity from hydrocarbon ingestion can
affect many different organs, but the lungs
are the most commonly affected organ...
Pathophysiology
• The toxicity of hydrocarbons is directly related
to their physical properties, specifically the
viscosit...
Pulmonary
• Pulmonary complications, especially aspiration,
are the most frequently reported adverse
effect of hydrocarbon...
• Cardiovascular
• Exposure to hydrocarbons can result in cardiotoxicity.
• Most importantly, the myocardium becomes
sensi...
Hepatic
• The chlorinated hydrocarbons, in particular carbon
tetrachloride, are hepatotoxic.
• Usually, the hepatotoxicity...
• Renal chronic exposure to toluene, an
aromatic hydrocarbon, can result in a distal
renal tubular acidosis
• Hematologic
...
Signs and symptoms
• Pulmonary toxicity most often occurs
following ingestion and subsequent aspiration
of hydrocarbon. Re...
• The most common CNS symptoms include headache,
lethargy, and decreased mental status.
• in addition, because of sensitiz...
Work up
• 1- CBC
• 2- LIVER ENZYMES
• 3- CHEST RADIOGRAPHY
• All symptomatic patients should have a chest x-
ray performed...
Managment
1. remove any remaining hydrocarbon that might be on the
clothes or skin
2. Patients should be kept calm to prev...
• Management for hydrocarbon intoxication
is largely supportive.
• Asymptomatic patients should be observed
with continual...
• Patients who show signs of impending respiratory failure
despite supplemental oxygen may require rapid sequence
intubati...
• The use of ipecac-induced emesis is
contraindicated, and activated charcoal does
not absorb hydrocarbons well.
• Antibio...
• THANK YOU
Toxicity of hydrocarbons
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Toxicity of hydrocarbons

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Toxicity of hydrocarbons

  1. 1. Toxicity of hydrocarbons
  2. 2. • Hydrocarbons are a heterogenous group of organic substances that are primarily composed of carbon and hydrogen molecules. They are quite abundant in modern society. • Some of the most commonly ingested hydrocarbons include gasoline, lubricating oil, motor oil, mineral spirits, lighter fluid/naphtha, lamp oil, and kerosene. • Other common sources of hydrocarbons include dry cleaning solutions, paint, spot remover, rubber cement, and solvents. • In addition, many volatile substances that contain hydrocarbons (eg, glue, propellants) are commonly abused for their euphoric effects.
  3. 3. • Hydrocarbons can be classified as being aliphatic, in which the carbon moieties are arranged in a linear or branched chain, or aromatic, in which the carbon moieties are arranged in a ring. • Halogenated hydrocarbons, in which one of the hydrogen molecules is substituted by a halogen group. The most important halogenated hydrocarbons include carbon tetrachloride, trichloroethylene, tetrachloroethylene, trichloroethane, chloroform, and methylene chloride.
  4. 4. • Toxicity from hydrocarbon ingestion can affect many different organs, but the lungs are the most commonly affected organ. • The chemical properties of the individual hydrocarbon determine the specific toxicity, while the dose and route of ingestion affect which organs are exposed to the toxicity. • Unlike the aromatic or aliphatic hydrocarbons, the halogenated hydrocarbons tend to cause a wider range of toxicity.
  5. 5. Pathophysiology • The toxicity of hydrocarbons is directly related to their physical properties, specifically the viscosity, volatility, surface tension, and chemical activity. • lower viscosity is associated with a higher chance of aspiration. • the surface tension is also inversely related to aspiration risk • the degree of volatility is directly related with the risk of aspiration.
  6. 6. Pulmonary • Pulmonary complications, especially aspiration, are the most frequently reported adverse effect of hydrocarbon exposure. • While most aliphatic hydrocarbons have little GI absorption, aspiration frequently occurs, either initially or in a delayed fashion as the patient coughs or vomits, thereby resulting in pulmonary effects. • Once aspirated, the hydrocarbons can create a severe pneumonitis.
  7. 7. • Cardiovascular • Exposure to hydrocarbons can result in cardiotoxicity. • Most importantly, the myocardium becomes sensitized to the effects of catecholamines, which can predispose the patient to tachydysrhythmias, which can result in syncope or sudden death. • Gastrointestinal • Many of the hydrocarbons create a burning sensation because they are irritating to the GI mucosa. • Vomiting has been reported in up to one third of all hydrocarbon exposures.
  8. 8. Hepatic • The chlorinated hydrocarbons, in particular carbon tetrachloride, are hepatotoxic. • Usually, the hepatotoxicity results after the hydrocarbon undergoes phase I metabolism, thereby inducing free radical formation. • These free radicals subsequently bond with hepatic macromolecules and ultimately cause lipid peroxidation. This metabolite creates a covalent bond with the hepatic macromolecules, thereby initiating lipid peroxidation. • The common histopathologic pattern is centrilobular (zone III) necrosis.
  9. 9. • Renal chronic exposure to toluene, an aromatic hydrocarbon, can result in a distal renal tubular acidosis • Hematologic • Prolonged exposure to certain aromatic hydrocarbons (especially benzene) can lead to an increased risk of aplastic anemia, multiple myeloma. • In addition, hemolysis has been reported following the acute ingestion of various types of hydrocarbons.
  10. 10. Signs and symptoms • Pulmonary toxicity most often occurs following ingestion and subsequent aspiration of hydrocarbon. Respiratory symptoms (eg, coughing, gagging, choking) usually occur within 30 minutes of exposure but often can be delayed several hours. • Lack of coughing does not exclude the possibility of aspiration. •
  11. 11. • The most common CNS symptoms include headache, lethargy, and decreased mental status. • in addition, because of sensitization of the myocardium to catecholamines, a relatively young and previously healthy patient can present in full cardiac arrest after being suddenly startled or following strenuous athletic events. • A common scenario for the cardiac arrest patient is the teenager who is huffing, or bagging alone in a dark room, who then gets startled when a parent opens the door. This "sudden sniffing death syndrome" results in ventricular fibrillation or ventricular tachycardia, following a large catecholamine exposure to a myocardium that is already sensitized to the effects of the catecholamines.
  12. 12. Work up • 1- CBC • 2- LIVER ENZYMES • 3- CHEST RADIOGRAPHY • All symptomatic patients should have a chest x- ray performed. • Patients who are asymptomatic (eg, no coughing or signs/symptoms of respiratory distress) should not have a chest radiograph obtained immediately. Rather, asymptomatic patients should have chest radiography performed at the end of a 6-hour observation period. • 4- ECG
  13. 13. Managment 1. remove any remaining hydrocarbon that might be on the clothes or skin 2. Patients should be kept calm to prevent arrhythmia as a result of myocardial sensitization. 3. All patients should have their airway, breathing, and circulation managed per routine advanced life support protocols. 4. Symptomatic patients should receive intravenous access and cardiac monitoring. 5. The hydrocarbon agent should be transported with the patient to the hospital, if this can be done in a safe manner. Bringing the substance to the hospital can permit identification.
  14. 14. • Management for hydrocarbon intoxication is largely supportive. • Asymptomatic patients should be observed with continual pulse-oximetry for a period of at least 6 hours. If the patient remains asymptomatic (eg, no coughing, vomiting, tachypnea, or other evidence of respiratory difficulties), then a chest radiograph may be obtained to evaluate for aspiration.
  15. 15. • Patients who show signs of impending respiratory failure despite supplemental oxygen may require rapid sequence intubation for definitive airway management. Intubation and positive pressure ventilation may be required for evidence of on-going respiratory distress. • If arrhythmias occur, electrolytes, including magnesium and potassium, should be replaced. • If ventricular fibrillation occurs, and the thought is that the arrhythmia is because of myocardial sensitization, catecholamines, including epinephrine, should be avoided. In this setting, lidocaine or beta-blockers can be used. • Decontamination of the GI tract remains controversial.
  16. 16. • The use of ipecac-induced emesis is contraindicated, and activated charcoal does not absorb hydrocarbons well. • Antibiotics are frequently given to patients who develop a pneumonitis following hydrocarbon aspiration. In animal models, the empiric administration of antibiotics altered the lung flora compared with controls and did not yield any benefit. Clinically, superinfection can definitely occur • Steroids have not been proven to be beneficial.
  17. 17. • THANK YOU

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