Can accidental ingestion of kerosene (petroleum-based solvent) cause impaired renal function?

Renal Effects of Accidental Kerosene Ingestion

Accidental kerosene ingestion can cause acute renal damage and should be managed promptly with supportive care, monitoring of renal function, and consideration of hemodialysis in severe cases.

Pathophysiology of Kerosene-Induced Renal Damage

Kerosene, a petroleum-based hydrocarbon solvent, can cause renal toxicity through several mechanisms:

• Direct nephrotoxicity of hydrocarbons that are absorbed systemically
• Hypoxemia from associated respiratory complications (aspiration pneumonitis)
• Metabolic acidosis that can worsen renal function
• Systemic inflammatory response to hydrocarbon exposure

Evidence of Renal Effects

The evidence supporting kerosene's nephrotoxic potential comes from case reports and observational studies:

• A case report documented acute renal failure following combined ingestion of metformin and kerosene oil 1
• Another case reported acute kidney failure after ingestion of Lava lamp liquid containing kerosene and other compounds 2
• Renal damage appears to be more common in cases with:
  • Larger volume ingestion
  • Systemic absorption
  • Concurrent metabolic derangements (especially acidosis)

Clinical Presentation and Assessment

When evaluating a patient with accidental kerosene ingestion, monitor for:

• Signs of renal dysfunction:
  • Decreased urine output
  • Fluid retention/edema
  • Electrolyte abnormalities
• Associated metabolic derangements:
  • Metabolic acidosis (particularly lactic acidosis)
  • Electrolyte imbalances
• Respiratory complications (common with kerosene):
  • Aspiration pneumonitis
  • Hypoxemia
  • Pleural effusions (including hemorrhagic effusions) 3

Management Approach

Immediate Management

1. Do not induce vomiting as it can cause re-exposure of the esophagus and increase risk of aspiration
2. Dilution with small amounts of water or milk (≤250 ml) if patient is conscious 4
3. Contact Poison Control Center for specific guidance

Supportive Care

1. Fluid therapy to correct hydroelectrolytic imbalances
2. Close monitoring of vital signs
3. Respiratory support as needed (oxygen, bronchodilators if bronchospasm occurs)
4. Pain management with appropriate analgesia

Renal Monitoring and Support

1. Regular assessment of renal function:
   • Serum creatinine and blood urea nitrogen
   • Urine output monitoring
   • Electrolyte levels
2. Maintain adequate hydration to support renal perfusion
3. Consider hemodialysis in cases of:
   • Severe metabolic acidosis unresponsive to medical management
   • Progressive renal failure
   • Significant electrolyte disturbances

Special Considerations

• Patients with pre-existing renal disease may be at higher risk for complications
• Combined ingestion with other nephrotoxic substances (like in the case of metformin and kerosene) may potentiate renal damage 1
• Children may be more susceptible to systemic effects due to higher body surface area to weight ratio

Prognosis and Follow-up

• Most cases of mild to moderate kerosene ingestion with prompt management have good renal outcomes
• Severe cases may require temporary dialysis support
• Follow-up renal function testing is recommended after discharge to ensure complete recovery
• Long-term renal sequelae are rare but possible in severe cases

Prevention

• Store kerosene in properly labeled containers away from food items
• Keep out of reach of children and individuals with altered mental status
• Educate about the dangers of hydrocarbon ingestion, particularly in regions where kerosene is commonly used for cooking and lighting

While respiratory complications are the most common and well-documented effects of kerosene ingestion 5, 6, renal toxicity represents an important but less recognized complication that requires vigilant monitoring and appropriate management.