Treatment of Turpentine Poisoning
Turpentine poisoning requires immediate supportive care focused on airway protection and hemodynamic stabilization, with gastric lavage and activated charcoal contraindicated due to high aspiration risk.
Immediate Management: Supportive Care Priority
The cornerstone of treatment is aggressive supportive care, not decontamination. The American Heart Association emphasizes that stabilization of vital functions must occur before specific toxin identification, with airway management and hemodynamic support taking absolute precedence over other interventions 1.
Critical Supportive Measures
Airway protection and respiratory support are paramount, as turpentine aspiration causes chemical pneumonitis that can progress to acute respiratory distress syndrome (ARDS), pneumatoceles, bronchopleural fistula, lung necrosis, and empyema 2, 3.
Hemodynamic monitoring and support with intravenous fluids and vasopressors (such as dopamine) are essential, as turpentine poisoning causes bradycardia and hypotension 4.
100% oxygen administration should be provided to maintain tissue oxygenation 5.
Close monitoring for at least 48-72 hours is required even in asymptomatic patients, as complications can develop over time 4.
Gastrointestinal Decontamination: CONTRAINDICATED
Do not perform gastric lavage or administer activated charcoal in turpentine poisoning. This is a critical pitfall that can worsen outcomes.
The FDA explicitly contraindicates activated charcoal for petroleum distillates including turpentine, as it provides no benefit and increases aspiration risk 6.
Gastric lavage must not be practiced because removing turpentine can provoke aspiration with consequent severe pulmonary disease 7.
The only exception is when ingestion exceeds 1 ml/kg and symptoms suggest life-threatening toxicity, but even then the risk-benefit ratio heavily favors avoiding gastric emptying 7.
Specific Complications Management
Pulmonary Complications
Chemical pneumonitis is the most common serious complication and requires supportive oxygen therapy, mechanical ventilation if needed, and close monitoring for progression to ARDS 2, 3.
Antibiotics should only be used if there is clear evidence of secondary bacterial infection, as turpentine itself can cause fever mimicking infection 7.
Corticosteroids do not modify the clinical course and are not routinely recommended 7.
Severe cases with lung necrosis, abscess formation, or bronchopleural fistula may require surgical intervention including intercostal tube drainage, decortication, or segmental resection 2, 3.
Cardiovascular Support
Hypotension responds to dopamine and aggressive intravenous fluid resuscitation, typically resolving within 2-3 days 4.
Bradycardia should be monitored but typically resolves with supportive care 4.
Additional Monitoring
Renal function monitoring is essential, as turpentine can cause hematuria and renal failure 4.
Vision assessment should be performed, as loss of vision has been reported 4.
Gastrointestinal bleeding surveillance is warranted, as gastroesophageal hemorrhage can occur 4.
Expert Consultation
- Contact regional poison control centers immediately (1-800-222-1222 in the United States) for specialized guidance from board-certified toxicologists 1, 5.
Common Pitfalls to Avoid
Never induce vomiting or perform gastric lavage unless the patient has ingested a massive, potentially lethal dose (>1 ml/kg), and even then the risks often outweigh benefits 6, 7.
Do not assume small ingestions are benign in children over 7 years old attempting self-harm, as they may ingest toxic quantities 7.
Do not routinely use corticosteroids, as they have not been shown to improve outcomes 7.
Remember that co-ingestions with alcohol or other substances can complicate the clinical picture and response to therapy 8.