What are the treatment and management options for engine oil ingestion?

Management of Engine Oil Ingestion

Immediate First Aid

Do not administer anything by mouth—no water, milk, or activated charcoal—unless specifically directed by a poison control center, and immediately contact the Poison Control Center (1-800-222-1222 in the US) while preparing for potential multi-organ toxicity. 1, 2, 3

• Do not induce vomiting or give ipecac, as this is contraindicated and provides no clinical benefit while potentially causing aspiration and harm. 1, 2
• Do not attempt gastric lavage, as petroleum distillates like engine oil can cause severe chemical pneumonitis if aspirated, and manipulation may worsen this risk. 1
• Activated charcoal is contraindicated for petroleum distillate ingestions (including engine oil, gasoline, kerosene) and should not be administered. 3

Emergency Medical Services Activation

Activate EMS immediately if the patient exhibits any life-threatening signs including altered mental status, seizures, respiratory difficulty (dyspnea, chest tightness), vomiting, or reduced consciousness level. 1, 2

• Engine oil ingestion can rapidly progress to acute respiratory distress syndrome (ARDS), chemical pneumonitis, and multi-organ failure requiring immediate intubation and mechanical ventilation. 4, 5
• Aspiration commonly occurs concomitantly with ingestion, leading to severe pulmonary complications within hours. 4, 5

Initial Clinical Assessment

Immediately assess airway, breathing, and circulation while monitoring for signs of aspiration pneumonitis including cough, dyspnea, hypoxemia, and tachypnea. 6, 4

• Obtain vital signs looking for tachycardia, hypotension (suggesting circulatory shock), fever, and oxygen desaturation. 4, 5
• Perform focused physical examination for respiratory distress, altered mental status (drowsiness, dizziness, agitation, coma), oral/pharyngeal mucosal injury, and abdominal tenderness. 2, 4, 5
• Look for CNS depression, as petroleum hydrocarbons cause central nervous system toxicity manifesting as altered consciousness, seizures, or coma. 2, 4

Laboratory and Imaging Evaluation

Obtain comprehensive laboratory workup including complete blood count, serum electrolytes, liver function tests, renal function tests, arterial blood gases (looking for metabolic acidosis), coagulation profile, and lactate levels. 6, 4, 7

• Engine oil ingestion can cause acute kidney injury requiring hemodialysis, liver dysfunction, disseminated intravascular coagulation (DIC), and coagulation factor deficiencies. 4, 7
• Obtain chest X-ray immediately to assess for aspiration pneumonitis, chemical pneumonia, or ARDS showing bilateral infiltrative shadows. 4, 5
• Consider chest CT if clinical deterioration occurs or if complications like pneumomediastinum are suspected. 5

Supportive Care and Monitoring

Provide aggressive supportive care with continuous cardiopulmonary monitoring in an intensive care setting for symptomatic patients. 4, 5

• Intubate and mechanically ventilate patients with respiratory failure or ARDS, using lung-protective ventilation strategies. 4, 5
• Administer corticosteroids (methylprednisolone) for severe chemical pneumonitis and ARDS. 5, 7
• Use bronchodilators and mucolytics (ambroxol, dihydroxypropylline) to manage bronchospasm and facilitate secretion clearance. 7
• Consider bronchoscopic alveolar lavage for severe cases with persistent respiratory compromise, along with pathogen culture and targeted antibiotic therapy for secondary infections. 7

Management of Complications

Initiate renal replacement therapy (hemodialysis or hemodiafiltration) for acute kidney injury with anuria or severe metabolic derangements. 4

• Manage circulatory shock with fluid resuscitation and vasopressor support as needed. 4
• Treat coagulation abnormalities with blood product transfusions (fresh frozen plasma, platelets) for DIC or specific factor deficiencies. 4, 7
• Consider plasma exchange therapy for severe multi-organ dysfunction not responding to conventional supportive measures. 4

Hospital Course and Prognosis

Anticipate prolonged hospitalization (potentially 3+ weeks) with risk of nosocomial infections, progressive organ dysfunction, and potential mortality despite aggressive treatment. 4, 5

• Mortality can occur even with optimal care, particularly when complicated by severe ARDS, sepsis, or multi-organ failure. 5
• Obtain psychiatric evaluation for intentional ingestions before discharge. 6

Critical Pitfalls to Avoid

Never give oral fluids or activated charcoal, as this increases aspiration risk and provides no benefit for petroleum distillate ingestions. 1, 3

• Do not delay intubation in patients with respiratory symptoms, as rapid progression to ARDS can occur within hours of ingestion. 4, 5
• Do not underestimate systemic toxicity, as engine oil contains polycyclic aromatic hydrocarbons (PAHs), benzene, toluene, ethylbenzene, xylene (BTEX), and toxic additives causing multi-organ damage beyond pulmonary injury. 8