Management of Petrol (Gasoline) Ingestion with Abdominal Burning
Do not induce vomiting, do not perform gastric lavage, and do not administer activated charcoal for petrol ingestion—these interventions are contraindicated and can worsen injury. 1, 2
Immediate Contraindications and Critical Actions
Activated charcoal is absolutely contraindicated for petroleum distillate ingestion (gasoline, kerosene, paint thinner) as it provides no benefit and may increase aspiration risk. 1
Gastric lavage is contraindicated for petroleum products as it increases the risk of aspiration pneumonitis and can cause further mucosal damage. 3, 2
Never induce vomiting with ipecac or any other method, as this dramatically increases aspiration risk and worsens pulmonary complications. 4, 2
Primary Management Strategy
Supportive care is the cornerstone of treatment since no specific antidote exists for petroleum product poisoning. 5, 2
Immediate Assessment Priorities
Evaluate respiratory status immediately as aspiration pneumonitis is the most serious complication, developing within hours and manifesting as dyspnea, cough, fever, and hemoptysis. 5, 6
Monitor for CNS depression including altered consciousness, as petroleum products can cause systemic toxicity beyond local gastrointestinal irritation. 2
Assess for signs of chemical pneumonitis including tachypnea, hypoxia, and chest pain, which may require chest radiography if symptoms develop. 5, 6
Symptomatic Management of Abdominal Burning
Provide supportive care for gastrointestinal symptoms with observation, as the burning sensation typically represents mucosal irritation that resolves with conservative management. 2
Avoid oral intake initially if the patient has significant symptoms, nausea, or risk of vomiting to minimize aspiration risk. 2
Consider small sips of water or milk only after ensuring the patient is fully alert and has no respiratory symptoms, though evidence for this is limited. 2
Monitoring and Observation Protocol
Observe for at least 6-8 hours even with small ingestions, as respiratory complications can develop with delayed onset. 2, 6
Key Monitoring Parameters
Serial respiratory assessments including respiratory rate, oxygen saturation, and auscultation for crackles or decreased breath sounds. 5, 6
Temperature monitoring as fever (up to 39°C) commonly develops within 12-24 hours with aspiration or systemic absorption. 6
Chest radiography is indicated if any respiratory symptoms develop (cough, dyspnea, chest pain, hemoptysis), as infiltrates and atelectasis may appear. 5, 6
Complications Requiring Escalation
Transfer to intensive care if the patient develops respiratory distress, hemoptysis, severe hypoxia, or multi-organ dysfunction. 5
Severe Complications Management
Mechanical ventilation may be required for severe chemical pneumonitis with respiratory failure, along with supportive hyperventilation and consideration of corticosteroids (prednisolone 50 mg daily). 5, 6
Vasopressor support and hemofiltration may be necessary in rare cases of multi-organ dysfunction syndrome with severe vasoplegia and renal failure. 5
Bronchoscopy with inhaled corticosteroids (beclomethasone) may be beneficial for severe eosinophilic alveolitis and mucosal necrosis. 6
Common Pitfalls to Avoid
Do not rely on the amount ingested alone to determine severity—even small volumes (10 mL) can cause life-threatening complications through aspiration. 5, 6
Do not discharge patients prematurely—pulmonary complications can develop hours after ingestion and progress to extensive necrotic lung changes requiring weeks of treatment. 6
Do not attempt decontamination procedures as the risk of aspiration far outweighs any theoretical benefit from removing gastric contents. 1, 2
Disposition and Follow-up
Admit for observation if any respiratory symptoms develop, if a significant volume was ingested (>1-2 mL/kg), or if intentional ingestion raises concern for repeat attempt. 4, 2
Psychiatric evaluation is mandatory for intentional ingestions to assess suicide risk before discharge. 3, 4
Outpatient management is appropriate only for truly asymptomatic patients with confirmed small accidental ingestions after 6-8 hours of observation showing no respiratory or systemic symptoms. 2