What is the treatment for phenol poisoning?

Treatment of Phenol Poisoning

Immediate decontamination with polyethylene glycol (PEG) followed by copious water and soap washing is the cornerstone of phenol poisoning treatment, while simultaneously calling emergency services and removing all contaminated clothing to prevent continued absorption. 1

Immediate Actions and Personal Protection

• Call emergency services or poison control center immediately while initiating treatment 1
• Healthcare workers must wear appropriate personal protective equipment including gowns and rubber gloves to prevent self-contamination 1, 2
• Remove all contaminated clothing and jewelry immediately to stop ongoing exposure 1, 2

Route-Specific Decontamination

Dermal Exposure (Most Critical)

• Apply undiluted polyethylene glycol (PEG) first as the preferred decontaminant, followed by thorough washing with copious amounts of water and soap 1, 2
• This sequence is critical because phenol is rapidly absorbed through skin—even small surface area exposures (3% body surface) can result in fatal serum levels and prolonged elimination half-lives up to 13.86 hours 3
• Aggressive early decontamination is essential as phenol creates a "slow-release reservoir" in skin tissue, leading to continued systemic absorption 3
• Do not use alcohol or mineral oil as these increase phenol absorption 2, 4

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 2
• Follow-up examination with fluorescein stain is recommended to assess for corneal abrasion 2

Ingestion

• Do not induce vomiting 1, 2
• Avoid administering alcohol, oral mineral oil, or dilution as these may increase absorption 1, 2, 4
• Gastric lavage is usually not recommended 2
• If advised by poison control, consider immediate administration of olive oil and activated charcoal via small-bore nasogastric tube 1, 2, 4
• Do not administer activated charcoal unless specifically advised by poison control or emergency medical personnel 1

Inhalation

• Administer 100% oxygen 2
• Intubation and assisted ventilation may be necessary 2

Systemic Complications and Treatment

Cardiovascular Management

• Treat hypotension with intravenous fluids and dopamine 2
• Manage ventricular arrhythmias with lidocaine 2, 4
• Monitor for both tachycardia and bradycardia, as well as atrial fibrillation 2, 3

Neurological Management

• Administer diazepam for seizures or severe agitation 2
• Monitor for altered mental status, confusion, vertigo, lethargy, or coma which can develop 5-30 minutes post-exposure 2, 3

Metabolic Complications

• Treat metabolic acidosis with 1-2 mEq/kg of sodium bicarbonate 2
• Treat methemoglobinemia if >30% or if respiratory distress is present with methylene blue 1-2 mg/kg of 1% solution administered slowly intravenously 2
• Monitor for hemolysis 2

Respiratory Support

• Establish airway management as needed 2
• Provide assisted ventilation if respiratory depression develops 2

Critical Pitfalls to Avoid

• Never delay decontamination: Phenol absorption is rapid and can be fatal even with small exposures; peak serum levels in the fatal range (21.6 μg/mL) have been documented from just 3% body surface area exposure 3
• Never use emetics, alcohol, or mineral oil for ingestions as these worsen absorption 1, 2, 4
• The lethal dose can be as little as 1 gram in adults or 50 mg in infants, making any significant exposure potentially life-threatening 2
• Phenol initially produces painless white skin patches that later turn erythematous and brown—the initial lack of pain should not provide false reassurance 2

Monitoring Requirements

• Establish vascular access early 2
• Monitor for delayed systemic manifestations including shock, dysrhythmias, seizures, and multi-organ complications 2, 5
• Hospital admission is warranted for any significant phenol ingestion (>1 g for adults or >50 mg for infants) or symptomatic intoxication 2
• Maintain continuous contact with poison control center for evolving treatment recommendations 1