What is the treatment for kerosene poisoning?

Treatment of Kerosene Poisoning

The treatment of kerosene poisoning is primarily supportive care focused on managing aspiration pneumonitis—do NOT induce vomiting, perform gastric lavage, or administer activated charcoal, as these interventions are explicitly contraindicated and increase aspiration risk.

Immediate Management and Contraindications

What NOT to Do (Critical)

• Never induce emesis or perform gastric lavage in kerosene poisoning, as these procedures dramatically increase the risk of aspiration due to kerosene's low viscosity, high volatility, and low surface tension 1, 2
• Do not administer activated charcoal, as it is contraindicated for petroleum distillates including kerosene and provides no benefit while increasing aspiration risk 1, 2
• Avoid neutralization attempts with any agents, as these are contraindicated and potentially harmful 3

Initial Assessment and Observation

• Keep all asymptomatic children under observation for at least 6 hours after exposure, as respiratory complications can develop during this window 2
• Assess for respiratory distress, which develops in approximately 77% of cases and represents the primary life-threatening complication 4
• Evaluate for CNS manifestations (confusion, lethargy, seizures), which occur in about 27% of cases and are likely secondary to hypoxia 4
• Monitor for vomiting, which occurs in approximately 63% of cases but does not appear to increase respiratory complications since aspiration typically occurs with initial ingestion 4

Respiratory Management

Oxygen Support and Monitoring

• Provide supplemental oxygen immediately for any patient with respiratory distress or hypoxemia 2
• Perform continuous respiratory monitoring including oxygen saturation, respiratory rate, and work of breathing 2
• Obtain chest X-ray on admission, as radiographic changes appear in approximately 60% of cases initially, and repeat imaging if clinical deterioration occurs 4
• Watch for delayed pleural effusions, which can develop more than 24 hours after ingestion 4

Indications for Intensive Care and Mechanical Ventilation

• Transfer to PICU and initiate early intubation and mechanical ventilation for patients with:
  • Severe respiratory distress unresponsive to supplemental oxygen 2
  • Severe hypoxemia despite oxygen therapy 2
  • Severe CNS depression or seizures 2
  • Inability to protect airway 2

Systemic Complications Management

Fluid Balance and Monitoring

• Carefully monitor fluid balance, as both dehydration from vomiting and fluid overload can worsen respiratory status 2
• Monitor for fever, which occurs in approximately 50% of hospitalized children and does not necessarily indicate bacterial superinfection 4
• Watch for severe gastric dilatation in severely ill patients, as this complication is associated with higher mortality 4

Antibiotic and Corticosteroid Use

• Do not routinely administer prophylactic antibiotics, as there is no clear benefit and aspiration pneumonitis is a chemical injury, not bacterial infection 2
• Do not routinely use corticosteroids, as evidence does not support benefit in kerosene-induced aspiration pneumonitis 2
• Consider antibiotics only if secondary bacterial pneumonia develops (fever beyond 48-72 hours, worsening clinical status, elevated inflammatory markers) based on clinical judgment 2

Special Considerations

CNS Manifestations

• Manage seizures with standard anticonvulsant therapy if they occur 2
• CNS symptoms (confusion, lethargy, seizures) are typically secondary to hypoxia rather than direct CNS toxicity 4
• Severe CNS involvement (convulsions) is associated with higher mortality and requires aggressive supportive care 4

Intentional Poisoning

• For intentional ingestion or injection cases, provide comprehensive wound care and surgical intervention if compartment syndrome or tissue necrosis develops 5, 6
• Mandatory psychiatric evaluation and treatment for depression are essential components of management for intentional poisoning 5, 6
• Intramuscular or intravenous injection of kerosene can cause compartment syndrome requiring urgent fasciotomy, repeated debridement, antibiotics, and prolonged follow-up 5, 6

Prognosis and Outcomes

• Mortality rate is low overall (approximately 2.5% in case series), with deaths occurring primarily from severe aspiration pneumonitis 2, 4
• Most children recover completely with supportive care alone 2
• Poor prognostic indicators include large volume ingestion, severe respiratory distress requiring mechanical ventilation, severe CNS depression, and development of gastric dilatation 4

Prevention Counseling

• Educate families about safe storage of kerosene away from children's reach 2
• Never store kerosene in beverage bottles or containers, as this is a major risk factor for accidental ingestion 2
• Promote safe cooking practices and community education about household poison prevention 2