What are the treatment guidelines for a patient with gasoline ingestion?

Management of Gasoline Ingestion

Immediate Priorities: Do NOT Induce Vomiting or Perform Gastric Lavage

The most critical principle in gasoline ingestion is to NEVER induce vomiting with ipecac or any other method, and NEVER perform gastric lavage, as these interventions are explicitly contraindicated and increase the risk of aspiration pneumonitis and esophageal perforation. 1

The primary cause of mortality and morbidity from gasoline ingestion is pulmonary aspiration, which can lead to chemical pneumonitis and acute respiratory distress syndrome (ARDS). 2, 3, 4

Initial Assessment and Stabilization

Airway and Respiratory Management

• Immediately assess airway patency and respiratory status - patients may present with acute respiratory failure requiring emergent intubation and mechanical ventilation. 2, 3
• Obtain chest X-ray and CT scanning to evaluate for aspiration pneumonitis, which can manifest as bilateral infiltrative pulmonary shadows. 2
• Be prepared for rapid deterioration to ARDS requiring advanced ventilatory support, including consideration of nitrogen oxide (NO) administration in severe cases. 3

Decontamination Principles

• Do NOT administer anything by mouth including water, milk, or activated charcoal unless specifically directed by poison control, due to the risk of emesis and aspiration. 1
• Remove all contaminated clothing immediately to prevent continued dermal absorption. 5
• The American Heart Association explicitly recommends against neutralization agents or antacids, as they provide no clinical benefit and may cause harm through exothermic reactions. 1

Contact Poison Control Immediately

• Call the Poison Control Center for guidance on systemic toxicity management while initiating supportive care. 1

Supportive Care and Monitoring for Complications

Multi-Organ System Monitoring

Gasoline ingestion can cause multi-organ dysfunction syndrome (MODS) beyond pulmonary toxicity:

• Cardiovascular: Monitor for circulatory shock and severe vasoplegia requiring high-dose vasopressors and massive fluid resuscitation. 3, 6
• Renal: Watch for acute kidney injury requiring hemofiltration or hemodialysis, which may develop within 24-48 hours. 2, 3, 6
• Hepatic: Monitor liver function tests for hepatic dysfunction. 2
• Hematologic: Check for disseminated intravascular coagulation (DIC) and, rarely, pancytopenia. 2, 4
• Metabolic: Assess for severe metabolic and lactic acidosis. 7

Advanced Therapies for Severe Cases

• Consider plasma exchange therapy for patients with severe multi-organ failure. 2
• Corticosteroids (prednisone) may be beneficial in managing chemical pneumonitis. 3
• Early aggressive supportive care is crucial as no specific antidote exists for gasoline poisoning. 3

Critical Pitfalls to Avoid

• Never delay intubation in patients with respiratory distress - aspiration may have already occurred at the time of ingestion, leading to immediate ARDS. 2
• Do not underestimate the severity based on initial presentation - patients can develop life-threatening complications within 24 hours. 3, 6
• Recognize that even small volumes (10 mL intravenously) can cause severe toxicity and multi-organ failure. 3
• Do not discharge without psychiatric evaluation - the majority of gasoline ingestions are intentional suicide attempts requiring mandatory psychiatric follow-up. 2, 3, 6, 4

Disposition and Follow-Up

• Admit all symptomatic patients to intensive care for close monitoring of respiratory and multi-organ function. 2, 3, 6
• Patients who develop ARDS or multi-organ failure require prolonged ICU stays (typically 12-21 days). 3, 6
• Transfer to psychiatric care facility is mandatory after medical stabilization for intentional ingestions. 3
• Complete recovery is possible with early aggressive supportive care, though mortality remains significant in severe cases with multi-organ failure. 3, 6