Emergency Management of Phenol Poisoning
Immediate decontamination with polyethylene glycol (PEG) is the preferred first-line treatment for phenol poisoning, followed by thorough washing with soap and water while removing all contaminated clothing and jewelry to prevent continued exposure. 1
Initial Assessment and Management
- Contact emergency services or poison control center immediately while initiating treatment for phenol poisoning 1
- Remove all contaminated clothing and jewelry to prevent continued exposure while avoiding self-contamination 1
- For dermal exposure, immediately decontaminate with polyethylene glycol (PEG) followed by thorough washing with soap and water 1, 2
- For eye exposure, flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 2
- Establish and maintain vital functions and establish vascular access 2
Route-Specific Management
Dermal Exposure
- Apply undiluted polyethylene glycol (PEG) immediately to the affected area, as it is superior to water alone for phenol decontamination 1, 3
- After PEG application, wash the area thoroughly with soap and water 2
- Be aware that prolonged skin contact with concentrated phenol in an occlusive environment may result in major absorption with a long elimination half-life (13.86 hours) even if the area involved is small 4
- Monitor for signs of systemic toxicity which may develop 5-30 minutes post-dermal application 2
Ingestion
- Avoid inducing emesis, alcohol, oral mineral oil, and dilution as these may increase absorption 2
- Gastric lavage is usually not recommended 2
- Administer olive oil and activated charcoal via small bore nasogastric tube 2, 5
Eye Exposure
- Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1
- Perform follow-up examination using fluorescein stain to check for corneal abrasion 2
Management of Systemic Toxicity
- Administer 100% oxygen; intubation and assisted ventilation may be necessary 2
- For shock: administer fluids and dopamine if needed 2
- For arrhythmias: consider lidocaine 2
- 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
- Consider large doses of vitamin C and glucocorticoids 6
- For severe cases with significant organ dysfunction, especially with TBSA >10%, consider blood purification techniques 6
Special Considerations
- Phenol is a general protoplasmic poison that denatures proteins and has corrosive local effects 2
- The lethal dose is between 3-30g, but may be as little as 1g 2
- Systemic manifestations may include nausea, vomiting, lethargy or coma, hypotension, tachycardia or bradycardia, dysrhythmias, seizures, acidosis, hemolysis, methemoglobinemia, and shock 2
- Dermal exposure initially produces painless white patches that later turn erythematous and finally brown 2
- Patients with burn surface area >10% are at higher risk for liver and kidney dysfunction 6
- Early surgical intervention may be necessary for extensive burns 6
Pitfalls to Avoid
- Do not delay decontamination while waiting for specialized equipment 7
- Avoid using alcohol-based products as they may cause further irritation 7
- Do not underestimate small area exposures, as concentrated phenol can cause severe systemic toxicity even with limited skin contact 4
- Healthcare personnel should use protective equipment including gowns and rubber gloves to prevent secondary exposure 2