What is the appropriate management for a patient with phenol poisoning?

Management of Phenol Poisoning

Immediately decontaminate with polyethylene glycol (PEG) followed by thorough soap and water washing, while simultaneously removing all contaminated clothing to prevent continued absorption. 1

Immediate Priorities and Decontamination

Call for Expert Guidance

• Contact your regional poison control center immediately (1-800-222-1222 in the United States) for specialized toxicological consultation, as phenol poisoning requires expert guidance that most clinicians use infrequently 2, 1

Remove Contaminated Materials

• Remove all contaminated clothing and jewelry immediately to prevent continued dermal absorption 1, 3
• Healthcare providers must wear gowns and rubber gloves to avoid secondary contamination 3

Skin Decontamination (Critical Step)

• Apply undiluted polyethylene glycol (PEG) to exposed skin first—this is the preferred decontaminant 1, 3
• After PEG application, wash the area thoroughly with copious amounts of water followed by soap and water 1, 3
• This two-step approach is essential because phenol is lipophilic and water alone is insufficient 3

Eye Decontamination

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes 1, 3
• Follow-up examination using fluorescein stain to assess for corneal abrasion is recommended 3

Gastrointestinal Decontamination (If Ingested)

What NOT to Do

• Do not induce vomiting under any circumstances 1, 3
• Do not administer alcohol or oral mineral oil, as these increase phenol absorption 1, 3
• Avoid dilution with water, which may paradoxically enhance absorption 3
• Gastric lavage is usually not recommended 3

What TO Do

• Administer olive oil immediately via small-bore nasogastric tube if advised by poison control 1, 3
• Follow with activated charcoal via nasogastric tube only if specifically advised by poison control 1, 3

Supportive Care and Management of Complications

Airway and Breathing

• Establish and maintain vital functions with standard life support measures 2
• Administer 100% oxygen by inhalation 3
• Intubation and assisted ventilation may be necessary for respiratory compromise 3

Cardiovascular Support

• Treat hypotension with intravenous fluids and dopamine if needed 3
• Manage ventricular arrhythmias with lidocaine 3, 4
• Monitor for both tachycardia and bradycardia, which can occur 3

Neurological Management

• Treat seizures with diazepam 3
• Monitor for altered mental status ranging from lethargy to coma 3

Metabolic Derangements

• Correct metabolic acidosis with 1-2 mEq/kg of sodium bicarbonate 3
• Treat methemoglobinemia if greater than 30% or if respiratory distress is present with methylene blue 1-2 mg/kg of 1% solution given slowly intravenously 3

Critical Pitfalls to Avoid

• Do not delay decontamination while waiting for confirmatory testing—treat based on history of exposure and clinical presentation 1
• Do not use water alone for skin decontamination; PEG must be applied first 3
• Do not give anything by mouth unless specifically advised by poison control 1
• Recognize that systemic manifestations develop rapidly (5-30 minutes post-exposure) and include cardiovascular collapse, seizures, and shock 3

Monitoring and Disposition

• The lethal dose of phenol can be as little as 1 gram, making all significant exposures (>1 g for adults or >50 mg for infants) require immediate medical evaluation 3
• Establish vascular access early for medication administration 3
• Prolonged observation is warranted due to potential for delayed systemic toxicity 3