Background and Etiology
- Definition of Hydrocarbon: compounds composed predominantly of carbon and hydrogen
- Industrial and Commercial Sources of Hydrocarbons: the hydrocarbons of greatest accessibility are derived from petroleum and wood
- Most of the dangerous hydrocarbons are derived from petroleum distillates and include aliphatic (straight-chain) hydrocarbons and aromatic (benzene-containing) hydrocarbons
- Common Hydrocarbons Associated with Human Exposures
- Citronella Oil
- Gasoline
- Jet Fuel
- Kerdan: aromatic hydrocarbon-enriched petroleum distillate
- Kerosene (Paraffin)
- Lamp Oil
- Lighter Fluid
- Mineral Seal Oil: mineral seal oil is found in furniture polish
- Mineral Spirits
- Turpentine (Pine Oil)
- Types of Hydrocarbon Exposure
- Unintentional or Intentional Ingestion
- Unintentional or Intentional Inhalation
- Dermal Exposure
Clinical Presentations
Hydrocarbon Ingestion with Aspiration Pneumonitis
- Physiology: accidental or intentional ingestion of hydrocarbons with subsequent aspiration
- Risk of aspiration is increased with lower viscosity and higher volatility of the hydrocarbon: mineral seal oil has low viscosity and is a particular risk
- Volatile hydrocarbons may displace alveolar oxygen, leading to hypoxia
- Although effects of hydrocarbon on pulmonary surfactant have been suggested to be contributory, the chemical pneumonitis due to hydrocarbons appears to be non-specific
- Hydrocarbon contact with alveolar membranes -> hemorrhage, hyperemia, edema, surfactant inactivation, leukocyte infiltration, and vascular thrombosis -> pneumonitis and acute lung injury
- Diagnosis
- CXR/Chest CT: infiltrates predominantly in aspiration-prone lung regions
- Clinical
- Pulmonary Manifestations (due to aspiration)
- Neuro Manifestations
- Initial Phase: disinhibition (similar to alcohol intoxication) or narcotic-like depression -> euphoria
- Later Phase: lethargy, headache, obtundation, coma
- Seizures: uncommon (likely are related to hypoxia)
- GI Manifestations
- Local irritation with abdominal pain and nausea
- Vomiting: increases likelihood of aspiration
- Cardiac Manifestations
- Arrhythmias: due to hypoxia, myocardial sensitization to catecholamines, and direct myocardial damage
- Sudden death: has been reported to occur as a result of coronary vasospasm due to hydrocarbons
- Hematologic Manifestations
- Other Manifestations
- Treatment: supportive care
- Prognosis: highest rates of morbidity and mortality result from accidental ingestion by children under 5 y/o
Fire Eater’s Lung
- Epidemiology: variant of hydrocarbon pneumonitis, which occurs predominantly in young adults who are exposed to hydrocarbons via their use in “fire-eating” displays
- Physiology: as above
- Clinical
- Pulmonary Manifestations (due to aspiration)
- Treatment: supportive care
Hydrocarbon Fume Inhalation
- Epidemiology
- Physiology: inhalation of hydrocarbon fumes (in contrast to aspiration of ingested hydrocarbons, as in seen in hydrocarbon aspiration pneumonitis)
- Clinical: main clinical features of hydrocarbon fume inhalation are usually neurologic and cardiac
- Pulmonary Manifestations
- Neuro Manifestations: common
- Cardiac Manifestations: common
- Treatment: supportive care
Other Manifestations
References
- Mineral spirits inhalation associated with hemolyis, pulmonary edema, and ventricular fibrillation. Ann Int Med 1991; 151: 1437-1440