What treatment is required for butanone (methyl ethyl ketone) inhalation?

Treatment for Butanone (Methyl Ethyl Ketone) Inhalation

For butanone inhalation exposure, immediately remove the patient from the exposure source, provide supportive care with supplemental oxygen to maintain adequate oxygenation, monitor for respiratory depression and central nervous system effects, and observe for at least several hours as there is no specific antidote.

Immediate Management

Remove from Exposure and Ensure Airway

• Immediately remove the patient from the contaminated environment to prevent continued exposure 1
• Assess and secure the airway, breathing, and circulation 1
• Provide fresh air and ensure adequate ventilation 1

Oxygen Therapy

• Administer supplemental oxygen via high-flow mask or nasal cannula to maintain oxygen saturation >94% 2
• For patients with significant respiratory depression, consider oxygen at 6-8 L/min via face mask 2
• Monitor oxygen saturation continuously with pulse oximetry 3

Clinical Monitoring

Assess for Toxicity

• Neurological effects: Monitor for altered mental status, confusion, drowsiness, dizziness, and potential loss of consciousness as butanone acts as a CNS depressant 1, 4
• Cardiac effects: Obtain ECG and monitor for arrhythmias, as aliphatic hydrocarbons like butanone can cause cardiac toxicity 1
• Respiratory effects: Assess for respiratory depression, irritation of mucous membranes, and adequacy of ventilation 1, 4
• Irritative symptoms: Evaluate for eye, nose, and throat irritation which commonly occur with ketone exposure 4

Laboratory and Diagnostic Studies

• Arterial blood gas if respiratory compromise is suspected 2
• Cardiac monitoring and serial ECGs given the risk of cardiac arrhythmias 1
• Consider toxicology screening if intentional exposure or coingestion is suspected 2

Supportive Care

Symptomatic Treatment

• No specific antidote exists for butanone toxicity; treatment is entirely supportive 1
• Treat bronchospasm if present with nebulized beta-agonists (salbutamol 5 mg or terbutaline 10 mg) 2
• For severe respiratory depression, be prepared to provide mechanical ventilation 1
• Manage cardiac arrhythmias according to standard ACLS protocols 1

Observation Period

• Observe symptomatic patients for at least 4-6 hours to monitor for delayed effects 1
• Patients with significant exposure or persistent symptoms require hospital admission for continued monitoring 1

Important Caveats

Potentiation Risk

• Be aware that methyl ethyl ketone (MEK/butanone) can potentiate the neurotoxicity of other solvents, particularly methyl n-butyl ketone, at ratios as low as 5:1 5
• If mixed solvent exposure is suspected (common in occupational or intentional abuse settings), anticipate potentially more severe toxicity 5

Intentional Exposure Considerations

• If exposure was intentional (substance abuse), consider coingestion of other substances including alcohol, which occurred in 66% of intentional poisoning cases in one study 2
• Mandatory psychiatric follow-up is required for all intentional exposures due to high risk of subsequent suicide attempts 2
• Young males are the predominant demographic for butane/ketone abuse 1

Delayed Effects

• While acute effects predominate, monitor for potential delayed neurological sequelae, particularly with prolonged or repeated exposures 6, 5
• Peripheral neuropathy can develop with chronic exposure to ketones, though this is more relevant to occupational rather than acute settings 6, 5

Follow-Up

Discharge Criteria

• Patient must be asymptomatic with normal vital signs and oxygen saturation on room air 1
• Normal mental status and neurological examination 1
• Stable cardiac rhythm 1

Post-Discharge Management

• For accidental exposures, provide education on avoiding future exposure 2
• For intentional exposures, arrange mandatory psychiatric evaluation before discharge 2
• Consider occupational medicine referral if exposure was work-related 6