What is the treatment for phenol poisoning in an emergency?

Emergency Management of Phenol Poisoning

For phenol poisoning in an emergency, immediate decontamination with polyethylene glycol (PEG) is the preferred treatment, followed by thorough washing with soap and water. 1, 2

Initial Management

• Call emergency services (911) or poison control center (1-800-222-1222) immediately while initiating treatment 1, 3
• Remove all contaminated clothing and jewelry to prevent continued exposure while avoiding self-contamination 1
• For healthcare providers, use appropriate personal protective equipment including gowns and rubber gloves when treating phenol exposure 2

Route-Specific Decontamination

Dermal Exposure

• Immediately decontaminate skin with copious amounts of water followed by undiluted polyethylene glycol (PEG) 2, 4
• After PEG application, wash the area thoroughly with soap and water 2
• Do NOT use alcohol or mineral oil as they may increase absorption 2

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 2
• Follow-up examination with fluorescein stain is recommended to check for corneal abrasion 2

Ingestion

• Do NOT induce vomiting 2
• Avoid alcohol, oral mineral oil, and dilution as they may increase absorption 2
• Gastric lavage is generally not recommended 2
• Administer olive oil and activated charcoal via small-bore nasogastric tube 2, 5

Systemic Management

• Establish and maintain vital functions (airway, breathing, circulation) 2
• Establish vascular access immediately 2
• Administer 100% oxygen; intubation and mechanical ventilation may be necessary 2
• For shock: administer IV fluids and vasopressors (dopamine) as needed 2
• For arrhythmias: administer lidocaine as indicated 2, 5
• For seizures: administer diazepam 2
• For metabolic acidosis: administer sodium bicarbonate 1-2 mEq/kg 2
• For methemoglobinemia >30% or with respiratory distress: administer methylene blue 1-2 mg/kg of 1% solution slowly IV 2

Advanced Interventions

• For severe cases (especially with TBSA >10%), consider:
  • Alkalization of urine to promote phenol excretion 6
  • High-dose vitamin C and glucocorticoids 6
  • Early surgical intervention for burns 6
  • Blood purification techniques (hemodialysis) for severe intoxication 6, 7

Monitoring and Follow-up

• Monitor vital signs, cardiac rhythm, respiratory status, and neurological function continuously 2, 5
• Obtain laboratory tests: complete blood count, electrolytes, renal and liver function tests, arterial blood gases, and methemoglobin levels 2, 6
• Systemic symptoms typically develop within 5-30 minutes post-exposure 2
• Patients with TBSA >10% are at higher risk for liver and kidney dysfunction 6

Prognosis and Complications

• Phenol poisoning can be life-threatening with approximately 50% mortality in severe cases 4
• Complications include respiratory failure, renal failure, liver dysfunction, metabolic acidosis, hemolysis, methemoglobinemia, and shock 2, 7
• Patients may require prolonged monitoring for persistent organ dysfunction, particularly pulmonary and renal complications 7

Common Pitfalls

• Failure to recognize the rapid absorption of phenol through all routes of exposure (dermal, inhalation, ingestion) 2
• Delayed decontamination allowing continued absorption and worsening toxicity 2, 4
• Using alcohol-based products for decontamination, which can increase phenol absorption 2
• Underestimating the severity of exposure based on initial presentation, as symptoms may develop or worsen over time 2, 7