What is the treatment for phenol poisoning?

Treatment for Phenol Poisoning

Immediate decontamination with polyethylene glycol (PEG) followed by copious water irrigation is the cornerstone of phenol poisoning management, combined with aggressive supportive care for systemic toxicity. 1

Immediate Actions and Contact

• Call poison control center (1-800-222-1222) or emergency services immediately upon suspicion of phenol exposure before initiating treatment 1
• Remove all contaminated clothing and jewelry immediately to prevent continued absorption and avoid self-contamination 1
• Do NOT induce vomiting, as this may worsen injury 1

Decontamination by Route of Exposure

Dermal Exposure (Most Critical)

• Apply undiluted polyethylene glycol (PEG) immediately as the preferred first-line decontaminant, as it is superior to water alone 1, 2
• After PEG application, wash the affected area thoroughly with copious amounts of soap and water 1, 3
• Time is critical: Even small surface area exposures (3% body surface area) with prolonged contact can result in fatal serum levels (>20 mcg/mL) and elimination half-lives exceeding 13 hours 4
• Aggressive early decontamination is essential because phenol creates a "slow-release reservoir" in skin tissue, leading to prolonged systemic absorption 4

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 3
• Follow-up examination with fluorescein stain to assess for corneal abrasion is recommended 3

Ingestion

• Do NOT administer anything by mouth (including activated charcoal, milk, or water) unless specifically directed by poison control center 1
• Avoid alcohol and oral mineral oil, as these increase phenol absorption 1, 3
• Gastric lavage is usually not recommended 3
• If advised by poison control, consider immediate administration of olive oil followed by activated charcoal via small-bore nasogastric tube for significant ingestions (>1 g in adults, >50 mg in infants) 3, 5

Inhalation

• Administer 100% oxygen to maintain tissue oxygenation 6
• Intubation and assisted ventilation may be necessary for respiratory depression 3

Systemic Supportive Care

Cardiovascular Management

• Establish vascular access immediately 3
• Treat hypotension with intravenous fluids first, then vasopressors (dopamine) if hypotension persists despite adequate fluid resuscitation 3
• Manage ventricular arrhythmias with lidocaine 3, 5
• Monitor for both tachycardia and bradycardia, as phenol can cause either 3

Neurological Management

• Treat seizures with diazepam 3
• Provide airway management and mechanical ventilation if altered mental status or respiratory failure develops 3
• Expect systemic manifestations 5-30 minutes post-exposure, including lethargy, coma, or seizures 3

Metabolic Derangements

• Correct metabolic acidosis with sodium bicarbonate 1-2 mEq/kg if present 3
• Treat methemoglobinemia if >30% or if respiratory distress present with methylene blue 1-2 mg/kg of 1% solution given slowly intravenously 3
• Monitor for hemolysis 3

Extracorporeal Treatment

• Charcoal hemoperfusion (CHP) should be considered for severe systemic phenol intoxication with high serum levels and refractory shock requiring large doses of vasopressors 7
• One case report demonstrated complete recovery after 6 hours and 20 minutes of CHP in a patient with severe intoxication (0.44 g/kg body weight), with clinical improvement correlating with decreasing phenol levels 7
• The role of hemodialysis is not well-established, but may be considered in severe cases 2

Critical Pitfalls to Avoid

• Never delay decontamination: Phenol is rapidly absorbed through skin, with peak serum levels occurring quickly even from small surface areas 4
• Do not use dilution techniques for ingestion: This may paradoxically increase absorption 3
• Avoid emesis: This worsens mucosal injury 3
• Healthcare personnel must use gowns and rubber gloves to prevent secondary contamination 3
• Do not underestimate small exposures: As little as 1 g can be lethal, and the typical lethal dose ranges from 3-30 g 3

Monitoring and Follow-up

• Monitor for delayed systemic toxicity including shock, arrhythmias, seizures, acidosis, and methemoglobinemia 3
• Observe for local tissue damage: phenol initially produces painless white patches that progress to erythematous and then brown discoloration 3
• Severe gastrointestinal burns and strictures are uncommon but possible with ingestion 3
• Urine may appear dark-green in severe poisoning 4