Management of Vasmol (Kerosene) Poisoning
The management of Vasmol (kerosene) poisoning is primarily supportive care focused on airway protection, preventing aspiration pneumonitis, and avoiding gastric decontamination procedures that increase aspiration risk.
Initial Stabilization and Assessment
- Immediately assess and secure the airway, breathing, and circulation as the first priority in any poisoned patient 1, 2
- Monitor for respiratory distress and hypoxia, as aspiration pneumonitis is the most serious complication of hydrocarbon ingestion 1
- Administer supplemental oxygen if hypoxia is present to correct oxygen saturation 1
- Obtain vital signs and assess mental status, as altered consciousness may indicate significant toxicity or hypoxia 1
Critical Management Principles
Gastrointestinal Decontamination - DO NOT PERFORM
- Gastric emptying procedures (induced emesis or gastric lavage) are contraindicated in kerosene poisoning due to high aspiration risk 3
- Activated charcoal is not indicated as hydrocarbons like kerosene are poorly adsorbed and administration increases aspiration risk 4, 3
- The primary toxicity from kerosene is aspiration pneumonitis, not systemic absorption, making GI decontamination both ineffective and dangerous 1
Supportive Care Measures
- Maintain adequate oxygenation and ventilation as the cornerstone of management 1, 2
- Provide mechanical ventilation if respiratory failure develops from severe aspiration pneumonitis 1
- Correct any acid-base disturbances, particularly metabolic acidosis that may develop 1
- Monitor for and treat secondary complications including pneumonia, pulmonary edema, or acute respiratory distress syndrome 2
Advanced Interventions for Severe Cases
Cardiovascular Support
- Consider VA-ECMO for persistent cardiogenic shock or cardiac arrest unresponsive to maximal treatment measures if cardiovascular collapse occurs 5, 6
- VA-ECMO is reasonable for persistent dysrhythmias when other treatment measures fail 5
- Poisoned patients managed with VA-ECMO have favorable outcomes as mechanical support allows time for poison elimination 6
Sedation for Agitation
- Administer sedation (benzodiazepines, antipsychotics, or ketamine) for severe agitation if present 5
- Avoid prolonged physical restraints without adequate sedation, as this is associated with death in severely poisoned patients 5, 7, 6
Monitoring and Disposition
- Observe all symptomatic patients for at least 6-8 hours for development of respiratory complications 1
- Patients exhibiting signs or symptoms of toxicity require extended monitoring as they can experience rapid clinical deterioration 1
- Asymptomatic patients with minimal exposure may be observed for shorter periods, but any respiratory symptoms mandate admission 2
- Children require particular attention as they can experience more profound effects from smaller exposures 1
Common Pitfalls to Avoid
- Never induce vomiting or perform gastric lavage - this dramatically increases aspiration risk and worsens outcomes 3
- Do not administer activated charcoal routinely, as it provides no benefit and increases aspiration risk 4, 3
- Avoid underestimating the severity in initially stable patients, as respiratory deterioration can occur hours after exposure 1
- Do not use physical restraints without effective sedation in agitated patients 5, 7