What is the treatment for phenol poisoning?

Treatment for Phenol Poisoning

For phenol poisoning, immediate decontamination with polyethylene glycol followed by water irrigation is the most effective first-line treatment, along with activated charcoal administration and supportive care for systemic effects. 1, 2

Initial Management

Decontamination

• Skin exposure:

  • Immediately remove contaminated clothing and jewelry 1
  • Apply undiluted polyethylene glycol (PEG) to affected areas 2, 3
  • Follow with copious water irrigation for at least 15 minutes 1
  • Wash thoroughly with soap and water after initial treatment 2

• Eye exposure:

  • Irrigate eyes with tepid water for at least 15 minutes 1, 2
  • Avoid contaminating unaffected eye 1
  • Follow-up examination with fluorescein stain to check for corneal abrasion 2

• Ingestion:

  • Do NOT induce vomiting - may worsen damage 2
  • Do NOT administer alcohol or mineral oil - increases absorption 2
  • Immediate administration of olive oil and activated charcoal via nasogastric tube 2, 4
  • Gastric lavage is generally not recommended 2

Airway and Breathing

• Ensure patent airway and provide 100% oxygen 5
• Intubation and mechanical ventilation may be necessary for respiratory depression 2

Circulation

• Establish IV access and administer fluids for hypotension 2
• For shock: fluid resuscitation and vasopressors (dopamine) 2
• For arrhythmias: antiarrhythmic medications (lidocaine) 2

Management of Systemic Effects

Metabolic Acidosis

• Administer sodium bicarbonate 1-2 mEq/kg for significant acidosis 2

Seizures

• Administer diazepam for seizure control 2

Methemoglobinemia

• If methemoglobin levels >30% or respiratory distress present:
  • Administer methylene blue 1-2 mg/kg of 1% solution slowly IV 2

Renal and Hepatic Dysfunction

• For significant phenol poisoning (TBSA >10% or ingestion >1g):
  • Monitor renal and hepatic function closely 6
  • Consider hemodialysis for severe cases with organ failure 7, 3
  • Promote elimination through diuresis and alkalization of urine 6
  • Administer large doses of vitamin C 6

Monitoring and Follow-up

• Continuous cardiac monitoring for at least 24-36 hours 5
• Serial assessment of vital signs and mental status 5
• Monitor for:
  • Respiratory depression
  • Hypotension
  • Cardiac arrhythmias
  • Seizures
  • Metabolic acidosis
  • Hemolysis
  • Methemoglobinemia
  • Renal and hepatic dysfunction

Special Considerations

• Health personnel should use appropriate PPE (gowns and rubber gloves) 2
• Phenol is rapidly absorbed through all routes (inhalation, dermal, ingestion) 2
• Lethal dose ranges from 1-30g, with as little as 1g potentially fatal 2
• Severity of systemic poisoning correlates with total body surface area affected 6
• Symptoms typically develop within 5-30 minutes post-exposure 2

Prognosis

• Approximately 50% of reported phenol poisoning cases have fatal outcomes 3
• Early and aggressive intervention significantly improves survival chances 3
• Patients may develop persistent pulmonary infiltrates requiring long-term follow-up 7