Management of Kerosene Ingestion
Immediate Assessment and Stabilization
Do NOT induce vomiting, perform gastric lavage, or administer activated charcoal in kerosene ingestion, as these interventions are contraindicated and significantly increase the risk of aspiration pneumonitis. 1, 2
Airway and Respiratory Management
Assess airway patency and respiratory status immediately, as aspiration pneumonitis is the most common and serious complication of kerosene ingestion due to its low viscosity, high volatility, and low surface tension. 1
Monitor for respiratory distress including tachypnea, retractions, grunting, cyanosis, and hypoxemia, which typically develop within the first few hours after ingestion. 1, 3
Provide supplemental oxygen for any child with respiratory symptoms or hypoxemia. 1
Intubate early and transfer to pediatric intensive care for children with severe respiratory distress, hypoxemia unresponsive to supplemental oxygen, or severe CNS depression. 1
Mechanical ventilation may be required in severe cases, though mortality remains low when respiratory support is provided promptly. 3
Initial Observation Period
Keep all asymptomatic children under observation for at least 6 hours after exposure, as respiratory complications can develop during this window. 1
Obtain chest radiograph on admission, recognizing that radiographic changes appear in approximately 60% of symptomatic children and may evolve over 24 hours. 3
Monitor for delayed complications including pleural effusions, which can occur beyond 24 hours post-ingestion. 3
Gastrointestinal Decontamination - What NOT to Do
Emesis, gastric lavage, and activated charcoal are absolutely contraindicated in kerosene ingestion. 1, 2
Aspiration occurs primarily during the initial ingestion event, not from subsequent vomiting, making induced emesis both ineffective and dangerous. 3
The presence of vomiting does not appear to increase the risk of respiratory complications, supporting the theory that aspiration happens at the time of ingestion rather than later. 3
Antibiotic Prophylaxis - Not Recommended
Do not administer prophylactic antibiotics routinely, as high-quality evidence demonstrates no benefit in preventing treatment failure or reducing hospital stay. 4
A double-blind randomized controlled trial showed no significant difference in treatment failures between antibiotic (5%) and placebo (9%) groups (RR 0.60,95% CI 0.11-3.37). 4
Kerosene causes a sterile chemical pneumonitis, not a bacterial infection initially. 4
Reserve antibiotics for documented secondary bacterial infections with clinical evidence (persistent fever beyond 48-72 hours, worsening respiratory status after initial improvement, elevated inflammatory markers). 1, 4
While one older study suggested possible benefit from ampicillin/metronidazole combination, the more recent and higher-quality randomized controlled trial supersedes this finding. 5, 4
Corticosteroids - Not Recommended
There is no clear benefit of corticosteroids in kerosene-associated pneumonitis. 1
Monitoring for Complications
Respiratory Complications
Monitor oxygen saturation continuously and obtain serial chest radiographs if respiratory symptoms develop or worsen. 1, 3
Watch for progression to acute respiratory distress syndrome requiring mechanical ventilation in severe cases. 3
Central Nervous System Manifestations
Assess for CNS depression, lethargy, confusion, or seizures, which occur in approximately 27% of children and are most likely caused by hypoxia rather than direct CNS toxicity. 3
Seizures are uncommon but represent severe toxicity requiring immediate intervention. 3
Gastrointestinal Complications
Monitor for severe gastric dilatation, which occurs in the most critically ill children and is associated with large-volume ingestions and higher mortality. 3
Consider nasogastric decompression if significant gastric dilatation develops. 3
Fever
Expect fever in approximately 50% of hospitalized children as part of the inflammatory response to chemical pneumonitis. 3
Fever alone without other signs of bacterial infection does not warrant antibiotic therapy. 4
Fluid Management
Monitor fluid balance carefully, as children with kerosene pneumonitis require judicious fluid administration to avoid pulmonary edema while maintaining adequate perfusion. 1
Disposition and Follow-up
Discharge asymptomatic children after 6 hours of observation if chest radiograph is normal and no respiratory symptoms develop. 1
Admit children with respiratory symptoms, abnormal chest radiograph, or significant CNS depression for continued monitoring and supportive care. 1, 3
Most children recover fully with supportive care alone, and mortality is low (approximately 2-3% in severe cases). 3