Management of Petrol (Gasoline) Ingestion
Do not induce vomiting, do not perform gastric lavage, and do not administer activated charcoal in patients who have ingested petrol, as these interventions are contraindicated and increase the risk of life-threatening aspiration pneumonitis. 1, 2
Immediate First Aid and Contraindications
Critical "Do Not" Actions:
- Do not give anything by mouth unless specifically directed by poison control 1, 3
- Do not induce vomiting or administer ipecac - this provides no benefit and significantly increases aspiration risk 1
- Do not perform gastric lavage - petroleum distillates cause severe chemical pneumonitis if aspirated, and manipulation worsens this risk 1
- Do not administer activated charcoal - the FDA label explicitly contraindicates its use for petroleum distillates such as gasoline, kerosene, and paint thinner 2
Immediate Actions:
- Contact Poison Control Center immediately while preparing for potential multi-organ toxicity 1
- Activate emergency medical services (EMS) if the patient exhibits any life-threatening signs including altered mental status, seizures, respiratory difficulty, vomiting, or reduced consciousness 1
Initial Clinical Assessment
Airway, Breathing, Circulation Priority:
- Immediately assess and secure airway, breathing, and circulation 1
- Monitor specifically for signs of aspiration pneumonitis: cough, dyspnea, hypoxemia, and tachypnea - these are the most critical complications 1, 4
Focused Physical Examination:
- Respiratory distress (primary concern) 1
- Altered mental status or CNS depression 1, 4
- Oral/pharyngeal mucosal injury 1
- Abdominal tenderness 1
Understanding the Pathophysiology
Petrol ingestion carries risk for multiple organ toxicity despite poor gastrointestinal absorption. Case reports document multi-organ failure including acute renal insufficiency requiring hemodialysis, respiratory failure, seizures, hemolysis, disseminated intravascular coagulation, and liver damage 5. The primary life-threatening complication is chemical pneumonitis from aspiration, not systemic absorption 4, 6.
Hospital Management
Supportive Care is the Cornerstone:
- No specific antidote exists for petroleum distillate poisoning 6
- Treatment is entirely symptomatic and supportive 4, 6
- Early aggressive supportive care may lead to favorable outcomes with minimal residual pulmonary sequelae 6
Potential Complications Requiring ICU-Level Care:
- Severe respiratory failure may require mechanical ventilation 6
- Multi-organ dysfunction syndrome (MODS) with severe vasoplegia requiring high-dose vasopressors 6
- Acute renal failure potentially requiring hemofiltration or hemodialysis 5, 6
- Hemorrhagic pulmonary edema and pneumonia 7
Psychiatric Evaluation
Before Discharge:
- Obtain psychiatric evaluation for all intentional ingestions before discharge, as these patients require further evaluation and treatment for underlying suicidal ideation 1
Common Pitfalls to Avoid
- Never delay EMS activation while attempting home remedies or decontamination 1
- Do not assume small volumes are safe - even 10 mL intravenously caused multi-organ dysfunction in case reports, though oral ingestion has different kinetics 6
- Do not discharge patients prematurely - complications can develop over hours, and multi-organ toxicity may be delayed 5
- Rescuer safety matters - petroleum products create toxic fumes; ensure adequate ventilation and avoid direct contact with vomit, which may contain volatile hydrocarbons 8, 7