What is the treatment for phenol poisoning?

Treatment for Phenol Poisoning

Immediately decontaminate with polyethylene glycol (PEG) for dermal exposure, followed by thorough soap and water washing, while for ingestion, administer olive oil and activated charcoal via nasogastric tube—never induce vomiting or give alcohol or mineral oil as these increase absorption. 1, 2

Immediate Actions and Personal Protection

• Call emergency services or poison control center (1-800-222-1222) immediately while initiating treatment 1
• Healthcare personnel must wear gowns and rubber gloves to prevent self-contamination during decontamination 1, 2
• Remove all contaminated clothing and jewelry immediately to prevent continued exposure 1
• Establish and maintain airway, breathing, and circulation as the absolute first priority 2

Route-Specific Decontamination

Dermal Exposure

• Apply undiluted polyethylene glycol (PEG) immediately to affected skin—this is the preferred first-line treatment 1, 3
• After PEG application, wash the area thoroughly with copious amounts of soap and water 1, 2
• Early PEG treatment decreases systemic phenol absorption and reduces severity of multi-organ complications 4, 3
• One survivor with 20.5% total body surface area burns and serum phenol levels of 17,400 micrograms/L recovered after immediate and repeated PEG treatment 3

Ingestion

• Do not induce vomiting—this is contraindicated 1, 2
• Avoid administering alcohol or oral mineral oil as they increase phenol absorption 1, 2
• Gastric lavage is usually not recommended 2
• Administer olive oil immediately via small bore nasogastric tube if advised by poison control 1, 2, 5
• Follow with activated charcoal via nasogastric tube 1, 2, 5

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 2
• Perform follow-up examination using fluorescein stain to assess for corneal abrasion 2

Inhalation

• Provide 100% oxygen inhalation 2
• Intubation and assisted ventilation may be necessary for respiratory depression 2

Management of Systemic Complications

Cardiovascular Support

• Administer intravenous fluids for hypotension 2
• Use dopamine for shock unresponsive to fluid resuscitation 2
• Treat ventricular arrhythmias with lidocaine 2, 5

Neurological Complications

• Administer diazepam for seizures 2
• Expect systemic manifestations to develop 5-30 minutes post-exposure 2

Metabolic Derangements

• Treat metabolic acidosis with 1-2 mEq/kg of sodium bicarbonate 2
• For methemoglobinemia greater than 30% or with respiratory distress, administer methylene blue 1-2 mg/kg of 1% solution slowly IV 2

Critical Pitfalls to Avoid

• Never dilute ingested phenol with water or other fluids—this may increase absorption 2
• Do not delay treatment waiting for toxicology confirmation; initiate management based on clinical presentation 2
• Avoid emesis induction as this causes re-exposure of the esophagus and oropharynx to phenol 1, 2
• Do not use alcohol or mineral oil orally as these enhance phenol absorption 1, 2

Severity Assessment

• The lethal dose ranges from 3-30 grams, but may be as little as 1 gram 2
• Significant ingestion is defined as more than 1 gram for adults or 50 mg for infants 2
• Roughly 50% of reported phenol poisoning cases have fatal outcomes, making aggressive early treatment essential 3
• Systemic toxicity includes coma, hypotension, dysrhythmias, seizures, acidosis, hemolysis, and shock 2, 5