What is the treatment for phenyl poisoning?

Treatment of Phenol Poisoning

Immediate decontamination with polyethylene glycol (PEG) followed by thorough soap and water washing is the preferred treatment for phenol exposure, while simultaneously calling poison control (1-800-222-1222) and removing all contaminated clothing to prevent continued absorption. 1

Immediate Actions and Decontamination

First Response Priorities

• Call poison control center (1-800-222-1222) or emergency services immediately while initiating treatment, as specialized toxicology guidance is critical for phenol poisoning management 1, 2
• Remove all contaminated clothing and jewelry immediately to prevent continued dermal absorption, with healthcare personnel using gowns and rubber gloves to avoid self-contamination 1, 3

Skin Decontamination (Most Common Route)

• Apply undiluted polyethylene glycol (PEG) to affected skin as the first-line decontamination agent, as it is superior to water alone 1, 3
• Follow PEG application with copious water irrigation, then wash thoroughly with soap and water 1, 3
• Avoid using alcohol or mineral oil, as these increase phenol absorption through the skin 1, 3

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 3
• Perform follow-up examination with fluorescein stain to assess for corneal abrasion 3

Ingestion Management

• Do NOT induce vomiting - this is contraindicated in phenol ingestion 1, 3
• Do NOT administer alcohol, oral mineral oil, or dilution - these increase absorption 1, 3
• Gastric lavage is generally not recommended due to risk of further mucosal injury 3
• If advised by poison control, consider immediate administration of olive oil followed by activated charcoal via small-bore nasogastric tube 1, 3

Airway and Respiratory Support

• Establish and maintain an open airway as the absolute first priority, providing bag-mask ventilation for respiratory depression 4
• Intubate and provide assisted ventilation if the patient cannot protect their airway or develops respiratory arrest (which can occur within 30 minutes post-ingestion) 4, 5
• Administer 100% oxygen by inhalation 3
• Monitor oxygen saturation continuously and provide supplemental oxygen to maintain adequate tissue oxygenation 4

Management of Systemic Complications

Cardiovascular Support

• Administer intravenous fluids for hemodynamic support 4
• For persistent hypotension despite fluid resuscitation, escalate to vasopressors (dopamine is specifically mentioned for phenol-induced shock) 3
• Treat ventricular arrhythmias with lidocaine 3
• Monitor for tachycardia, bradycardia, and dysrhythmias which can develop 5-30 minutes post-exposure 3

Seizure Management

• Administer diazepam 5-10 mg IV (adult) or 0.2-0.5 mg/kg IV (pediatric) as first-line therapy for seizures 4, 3
• Midazolam is an acceptable alternative 4
• Repeat benzodiazepine dosing every 5-10 minutes as needed to control seizure activity 4

Metabolic Acidosis

• Treat metabolic acidosis with sodium bicarbonate 1-2 mEq/kg IV 3

Methemoglobinemia

• Treat methemoglobinemia if greater than 30% or if respiratory distress is present 3
• Administer methylene blue 1-2 mg/kg of 1% solution slowly IV 3

Critical Pitfalls to Avoid

• Do NOT delay supportive care while waiting for toxicology confirmation or poison center callback - phenol can cause rapid deterioration 4
• Do NOT use neuromuscular blockers without adequate sedation - they mask seizure activity without treating the underlying neurological toxicity 4, 6
• Do NOT induce emesis or administer alcohol/mineral oil - these worsen toxicity 1, 3
• Do NOT perform gastric lavage routinely - the risk of further mucosal injury outweighs benefits in most cases 3

Prognostic Considerations

• The lethal dose ranges from 3-30 grams, but may be as little as 1 gram 3
• Significant phenol ingestion is defined as more than 1 gram for adults or 50 mg for infants 3
• Systemic manifestations typically develop 5-30 minutes after ingestion or dermal application 3
• Phenol causes extensive local corrosions with white patches initially, turning erythematous and finally brown, though these lesions are initially painless 3
• Survival is possible even after severe ingestion with appropriate aggressive supportive care 5