What is the treatment for gasoline ingestion?

Treatment for Gasoline Ingestion

Do not induce vomiting, do not perform gastric lavage, and do not administer activated charcoal for gasoline ingestion—these interventions are explicitly contraindicated and cause harm. 1, 2

Immediate Management

Airway Protection and Respiratory Support

• Secure the airway immediately and prepare for early intubation if any signs of respiratory distress, stridor, hoarseness, or drooling develop, as aspiration pneumonitis is the primary cause of morbidity and mortality in hydrocarbon ingestion. 3, 4, 5
• Administer 100% oxygen via non-rebreather mask or endotracheal tube to all patients, as gasoline vapors can cause severe chemical pneumonitis and respiratory failure. 6, 4
• Monitor continuously for signs of acute respiratory failure, as pulmonary aspiration is the major toxic effect and can progress rapidly to multi-organ dysfunction syndrome. 4, 5

Contact Poison Control Immediately

• Call the Poison Control Center immediately to receive agent-specific guidance on systemic toxicity management and determine if any special monitoring is required. 3
• Identify the quantity ingested, whether ingestion was accidental or intentional, and the time elapsed since exposure. 3

Critical Contraindications

• Never induce vomiting with ipecac or any other method—this is explicitly contraindicated as it increases aspiration risk and causes harm. 1, 2
• Do not administer activated charcoal for petroleum distillates like gasoline, as the FDA label specifically warns against its use in these cases. 2
• Do not perform gastric lavage or attempt any form of gastric emptying, as this increases the risk of aspiration and perforation. 1
• Do not give anything by mouth unless specifically directed by poison control, due to the risk of emesis and aspiration. 3

Initial Assessment and Monitoring

Vital Signs and Laboratory Evaluation

• Obtain vital signs with continuous cardiac monitoring, as gasoline can cause severe vasoplegia, hypotension, and tachyarrhythmia requiring high-dose vasopressors. 4, 7
• Draw blood for complete blood count (watch for pancytopenia, which has been reported), electrolytes, renal function, liver enzymes, arterial blood gas, and lactate level to assess for systemic toxicity and metabolic acidosis. 3, 5
• Monitor for multi-organ dysfunction syndrome, including renal failure requiring hemofiltration, as this can develop within 24 hours. 4

Imaging Studies

• Obtain chest radiograph immediately to evaluate for chemical pneumonitis, pulmonary edema, or aspiration, which are the primary complications. 4, 5
• Consider chest CT if clinical deterioration occurs, as it can show diffuse alveolar-toxic damage characteristic of hydrocarbon exposure. 8

Supportive Care

Respiratory Management

• Provide mechanical ventilation with supportive hyperventilation if gas exchange is severely impaired or respiratory failure develops. 4
• Consider administration of corticosteroids (prednisone) for severe chemical pneumonitis, though evidence is limited to case reports. 4
• Nitric oxide may be considered in severe cases with refractory hypoxemia, based on limited case report data. 4

Hemodynamic Support

• Administer massive fluid resuscitation and high-dose vasopressors if severe vasoplegia develops, which can occur within 24 hours and be life-threatening. 4, 7
• Prepare for potential need of hemofiltration if acute renal failure develops, which may require multiple sequential days of treatment. 4

Monitoring for Complications

• Watch for development of pancytopenia, which has been reported as a rare but serious complication requiring hematologic monitoring. 5
• Monitor for signs of metabolic acidosis, lactic acidosis, and multi-organ failure, which indicate severe systemic toxicity. 4, 7

Special Considerations

Psychiatric Evaluation

• Mandatory psychiatric evaluation and follow-up are required for all patients with intentional ingestion, as these patients have underlying psychiatric disease and high risk of repeat suicide attempts. 3
• Ensure psychiatric consultation before discharge and arrange mandatory follow-up. 3

Prognosis and Recovery

• With early and aggressive supportive care, complete recovery with minimal residual pulmonary sequelae is possible even after severe poisoning, though ICU stays of 12+ days may be required. 4
• No specific antidote exists for gasoline poisoning—treatment is entirely symptomatic and supportive. 4

Common Pitfalls to Avoid

• Do not delay airway management—respiratory compromise can develop rapidly and is the leading cause of mortality. 3, 4
• Do not attempt decontamination procedures like gastric emptying or activated charcoal administration, as these are contraindicated and harmful. 1, 2
• Do not underestimate systemic toxicity—gasoline can cause severe multi-organ dysfunction requiring intensive care beyond just pulmonary management. 4, 5, 7
• Do not discharge patients with intentional ingestion without psychiatric evaluation, as suicide risk remains extremely high. 3