What is the management of phenol poisoning?

Management of Phenol Poisoning

Immediate Decontamination

The priority in phenol poisoning is immediate decontamination with polyethylene glycol (PEG) followed by soap and water, while simultaneously removing all contaminated clothing to prevent continued absorption. 1

Dermal Exposure

• Remove all contaminated clothing and jewelry immediately to prevent ongoing exposure, with healthcare workers using appropriate personal protective equipment (gowns and rubber gloves) to avoid self-contamination 1, 2
• Apply undiluted polyethylene glycol (PEG) to affected skin areas first, as this is the preferred decontamination agent 1, 2
• After PEG application, wash the area thoroughly with copious amounts of soap and water 1, 2
• Avoid using water alone initially, as it may paradoxically increase toxicity - PEG should be applied first 2, 3
• Do not use alcohol or mineral oil for decontamination, as these increase phenol absorption 2
• Phenol produces characteristic white patches initially that turn erythematous and then brown, often with initial painlessness despite severe tissue damage 2

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

Ingestion

• Do not induce vomiting - this is contraindicated in phenol ingestion 1, 2
• Avoid administering alcohol, oral mineral oil, or dilution, as these may increase absorption 1, 2
• Do not perform gastric lavage routinely 2
• Administer olive oil followed by activated charcoal via small-bore nasogastric tube only if advised by poison control center 1, 2
• Activated charcoal should not be given unless specifically indicated by poison control 1

Emergency Contact and Assessment

• Contact poison control center (1-800-222-1222 in the United States) or emergency services immediately upon suspicion of phenol exposure 4, 1
• Establish and maintain vital functions with standard airway management, breathing support, and hemodynamic monitoring 4
• Establish vascular access early 2

Systemic Management

Respiratory Support

• Administer 100% oxygen by inhalation 2
• Intubate and provide assisted ventilation if respiratory distress develops, particularly with altered mental status or inability to protect airway 2

Cardiovascular Support

• Treat shock with intravenous fluids and dopamine as needed 2
• Manage dysrhythmias with lidocaine 2
• Monitor for both tachycardia and bradycardia, as either may occur 2

Metabolic Complications

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

Neurological Complications

• Treat seizures with diazepam 2
• Monitor for altered mental status ranging from lethargy to coma 2

Systemic Toxicity Timeline and Monitoring

• Systemic manifestations typically develop 5-30 minutes post-ingestion or post-dermal application 2
• Significant phenol ingestion is defined as more than 1 gram for adults or 50 mg for infants 2
• Monitor for nausea, vomiting, hypotension, dysrhythmias, seizures, acidosis, hemolysis, methemoglobinemia, and shock 2
• The severity and duration of systemic poisoning correlates with total body surface area (TBSA) affected, with patients having TBSA >10% showing obvious liver and kidney dysfunction 5

Additional Supportive Measures

• Promote diuresis and alkalinize urine to enhance elimination of absorbed phenol 5
• Administer large doses of vitamin C and glucocorticoids 5
• Consider blood purification techniques in severe cases with significant systemic absorption 5
• Observe symptomatic patients for at least 24 hours in a facility equipped with resuscitation equipment 2, 3

Critical Pitfalls to Avoid

• Never delay decontamination - the lethal dose may be as little as 1 gram, though typically ranges from 3-30 grams 2
• Do not use water as the initial decontaminant for dermal exposure - always use PEG first 2, 3
• Avoid oral administration of anything unless specifically directed by poison control 1
• Do not underestimate the severity based on initial painlessness of skin lesions - phenol causes protein denaturation and deep tissue damage 2
• Healthcare workers must protect themselves with appropriate PPE, as phenol is well absorbed through skin 2