From the Guidelines
The treatment for phenyl poisoning involves immediate decontamination and supportive care, with a focus on managing symptoms and preventing complications, as there is no specific antidote for phenol poisoning.
Key Considerations
- Remove the person from exposure and flush contaminated skin or eyes with copious amounts of water for at least 15 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
- Activated charcoal (1 g/kg body weight) may be administered if the phenol was ingested within the past hour.
- Supportive care is the mainstay of treatment, including maintaining airway, breathing, and circulation, as emphasized in the 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning 1.
Management of Systemic Toxicity
- Intravenous fluids help correct metabolic acidosis and maintain kidney function.
- Oxygen therapy and ventilatory support may be needed for respiratory distress.
- Seizures can be treated with benzodiazepines such as diazepam (5-10 mg IV for adults).
- Methylene blue (1-2 mg/kg IV over 5 minutes) may be used for methemoglobinemia.
Role of Hemodialysis
- Hemodialysis might be necessary in severe cases with significant metabolic acidosis or kidney failure, as suggested by the EXTRIP workgroup for the management of ethylene glycol poisoning 1.
Prioritization of Care
- The primary goal of treatment is to manage symptoms and prevent complications, as there is no specific antidote for phenol poisoning.
- Timely and effective supportive care, including airway management, hemodynamic support, and correction of critical vital sign and metabolic derangements, is essential to the care of the poisoned patient, as highlighted in the 2023 American Heart Association focused update 1.
From the Research
Treatment Overview
The treatment for phenyl poisoning involves immediate medical evaluation and establishment of vital functions.
- The patient should be given 100% oxygen to inhale, and intubation and assisted ventilation may be necessary in severe cases 2.
- Decontamination of the skin and eyes is crucial, using copious amounts of water, followed by undiluted polyethylene glycol for the skin, and tepid water for the eyes 2, 3.
Systemic Manifestations Treatment
Systemic manifestations such as shock, arrhythmias, and convulsions should be treated promptly.
- Shock can be managed with fluids and dopamine 2.
- Arrhythmias can be treated with lidocaine 2.
- Convulsions can be managed with diazepam 2.
- Metabolic acidosis should be treated with sodium bicarbonate, and methemoglobinemia can be treated with methylene blue if necessary 2.
Ingestion Treatment
If phenol is ingested, certain measures should be taken to minimize absorption.
- Emesis, alcohol, and oral mineral oil should be avoided, as they may increase absorption 2.
- Gastric lavage is usually not recommended, but immediate administration of olive oil and activated charcoal through a small bore nasogastric tube is necessary 2.
- The use of fomepizole, as seen in the treatment of ethylene glycol poisoning, is not directly relevant to phenol poisoning treatment 4, 5.
Local Manifestations Treatment
Local manifestations such as dermal exposure and eye irritation should be treated promptly.
- Dermal exposure should be treated with copious amounts of water, followed by undiluted polyethylene glycol, and then washed with soap and water 2, 3.
- Eye irritation should be treated with copious amounts of tepid water for at least 15 minutes, and a follow-up examination using fluorescein stain for corneal abrasion is recommended 2.