What is the appropriate management of a resorcinol overdose, including supportive care and specific interventions?

Management of Resorcinol Overdose

The management of resorcinol overdose centers on immediate stabilization through airway protection, respiratory support, and circulatory management, followed by aggressive treatment of life-threatening complications including seizures and severe metabolic acidosis. 1, 2

Immediate Stabilization and Supportive Care

Airway, Breathing, and Circulation

• Secure the airway immediately and provide mechanical ventilation for respiratory failure, which is a cardinal feature of resorcinol poisoning 1, 2
• Intubation and ventilatory support should be initiated without delay in patients presenting with unconsciousness or respiratory depression 1, 2
• Standard resuscitation protocols must be followed, with activation of emergency response systems as the first priority 3

Seizure Management

• Administer benzodiazepines as first-line therapy for generalized tonic-clonic seizures, which are a prominent feature of resorcinol toxicity 1, 2
• Seizures in resorcinol poisoning should be treated aggressively, as they contribute to metabolic acidosis and clinical deterioration 1, 2

Metabolic Derangements

• Correct severe metabolic acidosis aggressively, as this is a consistent and life-threatening finding in resorcinol overdose 1, 2
• Monitor and treat methemoglobinemia, which has been documented in fatal cases 1
• Anticipate and manage hypothermia, which may develop during the clinical course 2

Decontamination and Elimination

Gastrointestinal Decontamination

• Initiate decontamination measures as soon as possible after oral ingestion to prevent further absorption 1, 2
• The basic approach must include elimination of the toxin alongside stabilization of life-threatening problems 2

Monitoring for Systemic Absorption

• Resorcinol is readily absorbed from the gastrointestinal tract and rapidly metabolized, with over 90% excreted in urine within 24 hours 4
• Despite rapid metabolism, severe toxicity can occur with significant ingestions 1, 2

Clinical Monitoring and Laboratory Assessment

Essential Laboratory Studies

• Monitor for leukocytosis, which is consistently observed in resorcinol poisoning 1, 2
• Assess methemoglobin levels, particularly in severe cases 1
• Monitor liver function, as elevated bilirubin levels may occur 2
• Observe for green-colored urine, which is a characteristic finding 2
• Serial arterial blood gases to monitor metabolic acidosis 1, 2

Neurological Monitoring

• Assess for central nervous system effects including ataxia, recumbency, and tremors, which are documented effects of resorcinol toxicity 5
• Monitor level of consciousness continuously, as unconsciousness and drowsiness are prominent features 1, 2

Special Populations

Pregnancy Considerations

• Resorcinol poisoning in pregnancy carries significant fetal risk, with documented fetal death occurring 24 hours after maternal ingestion 2
• Pregnant patients require the same aggressive supportive management as non-pregnant patients 2
• The 2025 North American guidelines for hidradenitis suppurativa recommend avoiding resorcinol in pregnant patients due to lack of safety evidence 3

Critical Pitfalls to Avoid

• Do not delay mechanical ventilation in patients with respiratory compromise, as respiratory failure is a primary cause of mortality 1, 2
• Do not underestimate the severity of metabolic acidosis, which requires aggressive correction 1, 2
• Do not fail to treat seizures promptly with benzodiazepines, as seizure activity contributes to metabolic decompensation 1, 2
• Do not overlook methemoglobinemia, which may develop and require specific treatment 1

Prognosis and Recovery

• Maternal prognosis can be favorable with aggressive supportive management, even in severe cases 2
• Fatal outcomes have been documented despite intensive care, emphasizing the importance of early aggressive intervention 1
• No specific antidote exists for resorcinol poisoning; management is entirely supportive 1, 2