What is the treatment for chemical pneumonitis in children?

Treatment of Chemical Pneumonitis in Children

The treatment of chemical pneumonitis in children is primarily supportive care, focusing on oxygen therapy for hypoxemia, maintaining hydration, and providing symptomatic relief while avoiding unnecessary antibiotics unless secondary infection develops. 1, 2

Diagnosis and Initial Assessment

• Chemical pneumonitis should be suspected in children with:

  • History of exposure to hydrocarbons (turpentine, petrol, lamp oil) 3
  • Exposure to chlorine gas or other chemical irritants 2
  • Symptoms including coughing, shortness of breath, chest pain, vomiting, and fever 3, 2

• Diagnostic approach:

  • Initial chest X-ray may be normal for up to 48 hours after exposure 4
  • Follow-up chest X-ray after 24 hours is essential to confirm or exclude chemical pneumonitis 3
  • Complete blood count may show infectious pattern 3

Treatment Algorithm

1. Respiratory Support

• Provide supplemental oxygen for patients with oxygen saturation ≤92% via nasal cannulae, head box, or face mask to maintain saturation above 92% 1
• For severe cases with respiratory failure, endotracheal intubation and mechanical ventilation may be necessary 2
• Monitor oxygen saturation at least every 4 hours for patients on oxygen therapy 1

2. Fluid Management

• Ensure adequate hydration via oral or IV fluids 5
• If IV fluids are needed, administer at 80% of basal requirements and monitor serum electrolytes 1
• Consider IV hydration if the patient is unable to maintain oral intake or shows signs of dehydration 5

3. Symptomatic Relief

• Administer antipyretics and analgesics (acetaminophen or ibuprofen) to manage fever and discomfort 1, 5
• Minimize handling of severely ill children to reduce metabolic and oxygen requirements 1

4. Antibiotic Therapy

• Antibiotics are generally not indicated for pure chemical pneumonitis 3
• Consider antibiotics only if secondary bacterial infection is suspected, based on:
  • Persistent or worsening symptoms after 48 hours 1
  • New infiltrates on chest X-ray not explained by the initial chemical injury
  • Clinical deterioration despite supportive care

5. Monitoring and Follow-up

• Reassess the child after 48 hours; if still pyrexial or unwell, consider complications or secondary infection 1
• Consider pulmonary function studies after a few weeks to assess for long-term effects 3

Hospitalization Criteria

Admit children with chemical pneumonitis if they have:

• Oxygen saturation <92% or cyanosis 1
• Respiratory distress (respiratory rate >70/min in infants, >50/min in older children) 1
• Difficulty breathing, grunting, or intermittent apnea 1
• Inability to maintain oral hydration 1, 5
• Toxic appearance or severe symptoms requiring close monitoring 5

Complications to Monitor

• Acute complications:

  • Secondary bacterial pneumonia 4
  • Respiratory failure requiring mechanical ventilation 2

• Potential long-term complications:

  • Bronchiectasis
  • Bronchiolitis obliterans
  • Lung destruction 4

Prevention

• Patient and family education about proper storage of household chemicals
• Immediate removal from exposure source if chemical inhalation occurs
• Proper ventilation when using chemical cleaning agents

Important Caveats

• The initial chest X-ray may be normal despite significant exposure; delayed imaging (24-48 hours) is crucial for accurate diagnosis 4
• Chest physiotherapy is not beneficial and should not be performed in children with pneumonitis 1
• Nasogastric tubes may compromise breathing and should be avoided in severely ill children, especially infants 1
• Unlike bacterial pneumonia, chemical pneumonitis does not respond to antibiotics, making supportive care the cornerstone of treatment 3