What is the recommended withdrawal treatment for an adult patient with suspected turpentine exposure or ingestion?

Management of Turpentine Exposure

For turpentine ingestion, do NOT perform gastric lavage or induce vomiting due to high aspiration risk, do NOT administer activated charcoal, and focus treatment on supportive care with close monitoring for respiratory complications. 1, 2

Immediate Contraindications

• Do not use activated charcoal for turpentine ingestion, as the FDA explicitly contraindicates its use for petroleum distillates including turpentine 1
• Do not induce vomiting or perform gastric lavage, as removing turpentine can provoke aspiration leading to chemical pneumonitis in the majority of cases 2
• Gastric lavage should only be considered when ingestion exceeds 1 ml/kg body weight AND symptoms suggest severe toxicity, but this must be weighed against the substantial risk of aspiration-induced pulmonary complications 2

Supportive Care Strategy

• Provide aggressive supportive care focusing on airway management, respiratory support, and hemodynamic stabilization as the cornerstone of treatment, since there is no specific antidote for turpentine poisoning 3
• Administer intravenous fluids and vasopressors (such as dopamine) for hypotension, which is a common presenting feature 3
• Monitor and treat bradycardia if present, as cardiovascular instability can occur 3

Respiratory Monitoring and Management

• Closely monitor for chemical pneumonitis, which is the most serious complication of turpentine exposure and can progress to acute respiratory distress syndrome (ARDS), pneumatoceles, pneumothorax, or bronchopleural fistula 4
• Provide supplemental oxygen as needed for respiratory compromise 4
• Consider corticosteroids if significant pulmonary inflammation develops, though evidence suggests they may not substantially modify the clinical course 2, 4
• Ensure adequate ventilation of the treatment area to prevent secondary exposure to volatile hydrocarbons 4

Antibiotic Considerations

• Use antibiotics only if there is clear evidence of secondary bacterial infection, not prophylactically 2
• Remember that turpentine intoxication itself can cause fever, which should not be automatically interpreted as infection requiring antibiotics 2

Hospitalization and Observation

• Admit patients for close monitoring and observation, typically for 2-3 days minimum, even if initial presentation appears mild 3
• Monitor for delayed complications including renal failure (hematuria), gastrointestinal hemorrhage, vision loss, and throat swelling 3
• Perform serial laboratory investigations to detect organ dysfunction 3

Special Circumstances

• If turpentine ingestion is complicated by co-ingestion of other substances (such as alcohol or organophosphates), treatment becomes more complex and requires management of all toxic exposures simultaneously 5
• Keep the patient active and moving as tolerated 1

Common Pitfalls to Avoid

• Do not assume small ingestions are benign in older children or adults attempting self-harm, as they may ingest toxic quantities exceeding 1 ml/kg 2
• Do not overlook the potential for severe complications even when initial presentation shows minimal symptoms, as turpentine can cause delayed multi-organ toxicity 3, 6
• Do not confuse fever from turpentine toxicity itself with infectious complications requiring antibiotics 2