What is the appropriate acute management of phenol (phenyl) poisoning?

Management of Phenol Poisoning

Immediate Actions

Contact your regional poison control center immediately (1-800-222-1222 in the United States) while simultaneously initiating treatment, as phenol poisoning requires expert toxicological guidance that most clinicians encounter infrequently. 1

Life Support and Stabilization

• Prioritize airway, breathing, and circulation using standard BLS/ACLS protocols before attempting any decontamination procedures—supportive care determines survival in phenol poisoning. 2
• Secure the airway promptly and provide bag-mask ventilation or endotracheal intubation if respiratory depression develops, as respiratory arrest can occur within 30 minutes post-ingestion. 2, 3
• Establish intravenous access immediately for fluid resuscitation and medication administration. 3
• Monitor continuously for cardiovascular collapse, as phenol causes hypotension, tachycardia, bradycardia, and ventricular dysrhythmias. 3, 4

Decontamination by Route of Exposure

Dermal Exposure

• Remove all contaminated clothing and jewelry immediately to prevent continued absorption—healthcare personnel must wear gowns and rubber gloves to avoid self-contamination. 1
• Decontaminate skin with copious amounts of water, followed by undiluted polyethylene glycol (PEG) as the preferred agent, then wash thoroughly with soap and water. 1, 3
• Note that dermal lesions initially appear as painless white patches, then turn erythematous and finally brown—the initial lack of pain should not delay aggressive decontamination. 3

Eye Exposure

• Flush eyes immediately with copious amounts of tepid water for at least 15 minutes. 1
• Perform follow-up examination using fluorescein stain to assess for corneal abrasion. 3

Ingestion

• Do NOT induce vomiting, administer alcohol, oral mineral oil, or dilution—these interventions may increase phenol absorption. 1, 3
• Gastric lavage is generally not recommended due to lack of proven benefit and risk of complications. 3
• If advised by poison control, consider immediate administration of olive oil followed by activated charcoal via small-bore nasogastric tube. 1, 3
• Activated charcoal should only be given if the patient has a protected airway and can swallow safely. 5

Inhalation Exposure

• Administer 100% oxygen immediately, as inhalation produces respiratory tract irritation and pneumonia. 3
• Intubation and assisted ventilation may be necessary. 3

Management of Systemic Toxicity

Cardiovascular Complications

• Treat hypotension with intravenous fluids and dopamine if needed. 3
• Manage ventricular dysrhythmias with lidocaine—these arrhythmias are specifically related to phenol itself. 3, 4
• Administer atropine for severe bradycardia only after correcting hypoxemia. 2

Neurological Complications

• Treat seizures with diazepam (benzodiazepines are first-line for phenol-induced convulsions). 3
• Monitor for altered mental status ranging from lethargy to coma, which can develop 5-30 minutes post-exposure. 3

Metabolic Derangements

• Correct metabolic acidosis with sodium bicarbonate 1-2 mEq/kg intravenously. 3
• Monitor for and treat methemoglobinemia if greater than 30% or if respiratory distress is present—administer methylene blue 1-2 mg/kg of 1% solution slowly intravenously. 3
• Watch for hemolysis and selective elevation of uric acid. 4

Organ-Specific Monitoring

• Assess hepatic function, as phenol can cause liver injury. 3
• Monitor renal function closely—acute renal failure requiring hemodialysis can occur and may persist for weeks. 6
• Obtain chest imaging if respiratory symptoms develop, as pulmonary infiltrates can occur and may persist for months. 6

Critical Pitfalls to Avoid

• Do not delay airway management while attempting decontamination—respiratory arrest can occur rapidly. 2
• Do not assume a single exposure route—phenol is well absorbed by inhalation, dermal application, and ingestion simultaneously. 3
• Do not underestimate toxicity based on initial presentation—systemic manifestations can be delayed 5-30 minutes and include shock, seizures, and multi-organ failure. 3, 6
• The lethal dose ranges from 1-30 grams (as little as 50 mg in infants), so any significant exposure warrants immediate medical evaluation. 3

Disposition and Monitoring

• Admit all patients with significant phenol ingestion (>1 g for adults or >50 mg for infants) or any symptomatic intoxication for hospital monitoring. 3
• Continue monitoring for delayed organ dysfunction, particularly renal and pulmonary complications that may persist for months. 6
• Evaluate for psychological distress and suicide risk in cases of intentional self-poisoning before discharge. 5