What is the appropriate management for an adult who has ingested kerosene?

Management of Kerosene Ingestion in Adults

Kerosene ingestion in adults requires supportive care focused on preventing and managing aspiration pneumonitis, with gastric decontamination contraindicated due to high aspiration risk.

Immediate Assessment and Stabilization

Do not induce vomiting or perform gastric lavage - these interventions significantly increase aspiration risk and can cause life-threatening complications in hydrocarbon ingestion 1. The primary danger from kerosene is aspiration-induced chemical pneumonitis, not systemic absorption 2, 3.

Initial Evaluation

• Assess airway patency and respiratory status immediately, as respiratory failure can develop with delayed onset, leading to underestimation of illness severity 3
• Monitor for signs of aspiration including cough, dyspnea, tachypnea, and hypoxemia 2, 3
• Perform continuous cardiopulmonary monitoring, as cardiomyopathy can occur in severe cases 3
• Check electrolytes, particularly potassium, as persistent hypokalemia has been reported 3

Respiratory Management

For Symptomatic Patients with Aspiration

• Provide supplemental oxygen to maintain adequate oxygenation 3
• Consider mechanical ventilation for severe acute respiratory failure 3
• Obtain chest imaging (CT preferred over plain radiograph) to assess for consolidation, ground-glass opacities, bronchial wall thickening, and pleural effusion 2, 4

Advanced Interventions for Severe Lipoid Pneumonitis

Systemic corticosteroids combined with bronchoscopic segmental lavage can lead to rapid improvement in confirmed lipoid pneumonitis 2, 3. One case demonstrated marked resolution within one week of treatment with this approach 2.

• Perform bronchoscopy with bronchoalveolar lavage (BAL) to confirm diagnosis by identifying lipid-laden macrophages and neutrophilic alveolitis 2, 3
• Initiate systemic corticosteroids for patients with clinical deterioration or severe restrictive pulmonary disorder, though effectiveness varies 3
• Consider therapeutic segmental BAL in addition to diagnostic sampling for severe cases 2

Critical Pitfalls to Avoid

• Never use activated charcoal - kerosene is not effectively adsorbed and administration increases aspiration risk in a patient who may vomit 1
• Never perform gastric lavage - this carries serious adverse effects and dramatically increases aspiration risk with hydrocarbons 1
• Do not underestimate severity based on initial presentation - symptoms can have delayed onset, and patients may deteriorate hours after exposure 3
• Do not discharge asymptomatic patients immediately - observe for at least 6-8 hours as respiratory complications can develop with delay 3

Monitoring and Complications

Pulmonary Complications

• Monitor for development of chemical pneumonitis, which can progress to severe acute respiratory failure 3
• Watch for pleural effusion, which can be hemorrhagic in severe cases 4
• Assess for persistent restrictive pulmonary disorder requiring prolonged corticosteroid therapy 3

Cardiovascular Complications

• Monitor cardiac function as cardiomyopathy occurs in a significant proportion of severe cases 3
• Perform ECG and consider cardiac biomarkers if cardiovascular symptoms develop 3

Disposition

• Admit all symptomatic patients for continuous monitoring and respiratory support 3
• Observe asymptomatic patients for minimum 6-8 hours before considering discharge 3
• Arrange follow-up imaging for patients with confirmed pneumonitis to document resolution 2
• The fatality rate is high in severe kerosene intoxication with aspiration, particularly when complicated by cardiac involvement 3