What is the treatment for carbolic acid (phenol) poisoning?

Treatment of Carbolic Acid (Phenol) Poisoning

Immediately decontaminate exposed skin with copious running water for at least 15 minutes followed by undiluted polyethylene glycol, then wash thoroughly with soap and water—this is the single most critical intervention to prevent systemic absorption and reduce mortality. 1

Immediate Decontamination and First Aid

Dermal Exposure

• Remove all contaminated clothing and jewelry immediately to prevent continued chemical contact with skin 2
• Irrigate exposed skin with copious running water for at least 15 minutes, as immediate irrigation significantly reduces tissue damage and systemic absorption 2, 1
• After water irrigation, apply undiluted polyethylene glycol to the affected area, followed by thorough washing with soap and water 1
• Healthcare personnel must wear gowns and rubber gloves to avoid secondary contamination 1

Eye Exposure

• Immediately flush eyes with copious amounts of tepid water for at least 15 minutes 1
• Assist the patient in keeping eyelids open during irrigation 2
• Follow-up examination using fluorescein stain is recommended to assess for corneal abrasion 1

Ingestion

• Do NOT induce vomiting, as this is explicitly contraindicated and increases risk of aspiration and re-exposure of the esophagus 2, 1
• Avoid alcohol, oral mineral oil, and dilution attempts, as these may increase phenol absorption 1
• Gastric lavage is usually not recommended due to risk of perforation and re-exposure 1
• Immediately administer olive oil followed by activated charcoal via small-bore nasogastric tube if the patient can safely tolerate it 1

Emergency Stabilization

Airway and Breathing

• Secure the airway immediately, as phenol ingestion causes extensive mucosal burns and potential airway compromise 2, 1
• Prepare for early intubation if respiratory distress develops 2
• Administer 100% oxygen by inhalation 1
• Assisted ventilation may be necessary in severe cases 1

Circulation and Vital Signs

• Establish vascular access immediately 1
• Treat shock with intravenous fluids and dopamine if hypotension persists 1
• Monitor for both tachycardia and bradycardia, as phenol can cause either 1
• Treat arrhythmias with lidocaine 1

Management of Systemic Complications

Metabolic Acidosis

• Administer 1 to 2 mEq/kg of sodium bicarbonate intravenously for metabolic acidosis 1
• Monitor arterial blood gases and adjust treatment accordingly 1

Methemoglobinemia

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

Neurological Complications

• Treat seizures with diazepam 1
• Monitor for lethargy, coma, and altered mental status, which can develop 5 to 30 minutes post-exposure 1

Poison Control Center Consultation

• Contact the Poison Control Center (1-800-222-1222) immediately for guidance on systemic toxicity management and agent-specific recommendations 2, 3
• Identify the concentration of phenol ingested, as pure phenol is more toxic than phenol derivatives 1
• The lethal dose ranges from 3 to 30 grams, but may be as little as 1 gram 1

Critical Monitoring and Follow-up

• Immediate medical evaluation is required for ingestion of more than 1 gram in adults or 50 mg in infants, or any symptomatic intoxication 1
• Monitor for multi-organ complications including renal failure, pulmonary toxicity, hemolysis, and hepatic dysfunction 4, 5
• Hemodialysis may be necessary for acute renal failure 5
• Persistent pulmonary infiltrates may require months to resolve 5

Common Pitfalls to Avoid

• Never use activated charcoal alone without olive oil pretreatment, as phenol is a corrosive agent requiring specific decontamination 1
• Never delay skin decontamination, as phenol is rapidly absorbed through all routes (dermal, inhalation, ingestion) 1, 4
• Do not underestimate severity based on initial painless white skin patches, as these progress to erythematous and brown lesions indicating deeper tissue damage 1
• Recognize that systemic manifestations can develop rapidly (5-30 minutes) after exposure, requiring immediate intensive care 1, 4