What is the treatment for diesel intoxication?

Treatment of Diesel Intoxication

For acute diesel intoxication, immediately remove the patient from exposure, decontaminate thoroughly, provide aggressive supportive respiratory care with early intubation if needed, and do NOT induce vomiting or use activated charcoal for ingestion due to high aspiration risk.

Immediate Decontamination and Scene Safety

• Remove all contaminated clothing immediately and ensure the patient is moved away from the source of exposure to prevent continued absorption through skin or inhalation 1, 2.
• Irrigate exposed skin with copious amounts of water for at least 15 minutes, removing any chemical residue before washing 2.
• Healthcare personnel must protect themselves from secondary contamination by wearing appropriate personal protective equipment 2.
• Decontamination should ideally occur outside the medical facility to prevent contamination of healthcare staff and hospital areas 2.

Airway and Respiratory Management

The respiratory system is the primary target organ in diesel poisoning, whether from aspiration after ingestion or direct inhalation 3, 4, 5.

• Assess for respiratory distress, chest tightness, dyspnea, and signs of chemical pneumonitis immediately upon presentation 5.
• Provide early endotracheal intubation and mechanical ventilation for patients with significant respiratory distress rather than waiting for deterioration 5.
• Administer bronchodilators and corticosteroids (such as methylprednisolone) to reduce airway inflammation and bronchospasm 5.
• Consider repeated bronchoscopic alveolar lavage for severe cases with persistent respiratory compromise 5.
• Monitor closely for development of pneumomediastinum, which can occur from extensive erosion of the oesophagus in ingestion cases 3.

Critical "Do Not" Interventions

Do NOT induce vomiting in diesel ingestion cases - this significantly increases the risk of aspiration and chemical pneumonitis, which is the primary cause of morbidity and mortality 3, 4.

Do NOT administer activated charcoal - while activated charcoal is indicated for many poisonings 6, it is contraindicated in hydrocarbon ingestions like diesel due to aspiration risk and lack of efficacy for volatile petroleum distillates.

Supportive Care and Monitoring

• Provide aggressive supportive care including intravenous fluids and hemodynamic monitoring 5.
• Monitor for coagulation abnormalities, particularly factor VII deficiency, which has been reported in diesel inhalation cases 5.
• Administer blood product transfusions if coagulation disorders develop 5.
• Implement targeted antibiotic therapy based on pathogen cultures if nosocomial infections develop during prolonged hospitalization 3, 5.
• Monitor for multi-organ involvement as diesel has toxic potential affecting multiple organ systems beyond the respiratory tract 3.

Specific Pharmacotherapy

• Ambroxol can be administered to enhance mucociliary clearance and reduce respiratory secretions 5.
• Dihydroxypropylline (aminophylline) may be used for bronchodilation in cases with significant bronchospasm 5.
• Methylprednisolone or other corticosteroids should be given to reduce inflammatory response in the airways 5.

Gastrointestinal Considerations for Ingestion

• Assess for extensive erosion of the oral cavity, oesophagus, and gastric mucosa, which can occur with diesel ingestion and may resemble corrosive injury 3, 7.
• Monitor for gastrointestinal perforation or mediastinal complications 3.
• Consider early gastroenterology consultation for severe mucosal injury 3.

Contact Poison Control

• Immediately contact a poison control center (1-800-222-1222) for expert guidance on ongoing management and monitoring 1, 6.

Common Pitfalls to Avoid

• Do not delay intubation in patients with respiratory distress - early mechanical ventilation improves outcomes 5.
• Do not underestimate the severity based on initial presentation - patients may initially respond well but develop delayed complications including nosocomial infections during prolonged hospitalization 3.
• Do not forget to monitor coagulation studies as diesel inhalation can cause unexpected coagulation factor deficiencies 5.
• Do not assume single-system involvement - diesel affects multiple organs and requires comprehensive monitoring 3, 8.

Prognosis and Long-term Considerations

• Patients typically require prolonged hospitalization even with appropriate treatment 3.
• Mortality can occur despite aggressive supportive care, particularly when complicated by nosocomial infections 3.
• Chronic exposure to diesel exhaust (occupational or environmental) is associated with long-term cardiovascular and respiratory morbidity 9, 8.