What is the emergency management of a patient with suspected phenyl‑related poisoning?

Emergency Management of Phenyl (Phenol) Poisoning

Immediately decontaminate the skin with copious water followed by undiluted polyethylene glycol, secure the airway if respiratory distress is present, and contact Poison Control (1-800-222-1222) for specialized guidance—phenol is a corrosive protoplasmic poison requiring rapid intervention to prevent systemic toxicity and death. 1

Immediate Recognition and Stabilization

Phenol poisoning requires immediate medical evaluation for any significant ingestion (>1 g in adults or >50 mg in infants) or symptomatic intoxication. 1

• Establish and maintain vital functions immediately using standard BLS/ACLS protocols—airway, breathing, and circulation take absolute priority over all other interventions. 2
• Contact Poison Control (1-800-222-1222) immediately for specialized toxicological guidance, as most clinicians rarely encounter phenol poisoning and require expert consultation. 2, 3
• Healthcare personnel must wear gowns and rubber gloves to prevent secondary exposure during decontamination and treatment. 1

Critical First Steps: Decontamination

Dermal Exposure (Most Common Route)

• Immediately decontaminate the skin with copious amounts of water, followed by undiluted polyethylene glycol application—this is the specific antidote for dermal phenol exposure. 1
• After polyethylene glycol treatment, wash the area thoroughly with soap and water. 1
• Do NOT delay decontamination—phenol is well absorbed through skin and produces initially painless white patches that later turn erythematous and brown. 1

Ocular Exposure

• Immediately irrigate eyes with copious amounts of tepid water for at least 15 minutes. 1
• Follow-up examination using fluorescein stain is recommended to assess for corneal abrasion. 1

Ingestion

• Do NOT induce emesis—this increases aspiration risk and worsens corrosive injury. 1
• Avoid alcohol, oral mineral oil, and dilution with water, as these increase phenol absorption. 1
• Gastric lavage is usually NOT recommended due to corrosive injury risk. 1
• Immediately administer olive oil followed by activated charcoal via small-bore nasogastric tube if ingestion occurred and airway is protected. 1

Airway Management

• Secure the airway immediately if respiratory distress, altered mental status, or respiratory tract irritation develops—intubation and assisted ventilation may be necessary. 1
• Administer 100% oxygen by inhalation for all symptomatic patients. 1
• Inhalation exposure produces respiratory tract irritation and pneumonia requiring aggressive respiratory support. 1

Systemic Toxicity Management

Systemic manifestations develop 5-30 minutes post-ingestion or dermal application and include lethargy, coma, hypotension, dysrhythmias, seizures, acidosis, hemolysis, methemoglobinemia, and shock. 1

Cardiovascular Support

• Treat shock with intravenous fluids and dopamine. 1
• Manage dysrhythmias with lidocaine—standard ACLS protocols apply. 1
• Monitor for both tachycardia and bradycardia, as phenol can cause either. 1

Seizure Management

• Administer diazepam for seizures—benzodiazepines are first-line therapy. 1

Metabolic Acidosis

• Treat metabolic acidosis with 1-2 mEq/kg of sodium bicarbonate intravenously. 1

Methemoglobinemia

• Treat methemoglobinemia if levels exceed 30% or if respiratory distress is present with methylene blue 1-2 mg/kg of 1% solution administered slowly intravenously. 1

Diagnostic Workup

• Monitor for hemolysis, methemoglobinemia, metabolic acidosis, and shock—these are the life-threatening systemic complications. 1
• Assess for gastrointestinal burns, though severe burns and strictures are uncommon with phenol compared to other caustics. 1

Critical Pitfalls to Avoid

• Never delay decontamination—phenol is rapidly absorbed through all routes (dermal, inhalation, ingestion) and systemic toxicity develops within 5-30 minutes. 1
• Never use alcohol, mineral oil, or dilution for ingestions—these increase absorption and worsen toxicity. 1
• Never induce emesis—this causes aspiration of corrosive material. 1
• Never forget personal protective equipment—healthcare workers are at risk of secondary exposure from contaminated skin, clothing, and gastric contents. 1
• Do not underestimate the lethal dose—as little as 1 g can be fatal, though the typical lethal range is 3-30 g. 1

Monitoring and Disposition

• All symptomatic patients require emergency department evaluation and hospital admission for continuous monitoring. 1
• Monitor for delayed complications including pneumonia from inhalation, renal damage from hemolysis, and cardiovascular collapse. 1
• Psychiatric evaluation is mandatory for all intentional ingestions before discharge. 2