Hydrocarbons

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