2 Problem (Emergency Medicine)

nd
Yenny Darmawan
405180099
Group 9
Intoxication of Hydrocarbon
Hydrocarbon
• Hydrocarbons are a diverse group of organic compounds that contain
hydrogen and carbon.
• Most hydrocarbons (eg, gasoline) are byproducts of crude oil and are
therefore called petroleum distillates.
• Hydrocarbons are used as solvents and diluents in many products, such as
household cosmetics and chemicals, pesticides, fuels, and essential oils.
• The two main categories of hydrocarbons are:
• Aliphatic  straight chain structures (propane)
• Aromatic  cyclic structures (toluene).
• Although the range of toxicity of hydrocarbons can vary widely, the
majority of human exposures are confined to petroleum distillates
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Tintinalli’s Emergency Medicine Manual 2018
Rosen’s Emergency Medicine. 2017
• Exposures to hydrocarbons are typically via inhalation, ingestion (with
potential aspiration), and dermal.
• Inhalational exposures  typically due to either intentional abuse
of volatile hydrocarbons (huffing) or household and workplace
exposures.
• Ingestions  mostly due to accidental pediatric exposures, which
also can lead to aspiration and pneumonitis.
• Dermal exposures  from household or workplace exposures and
rarely intentional.

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Pathophysiology
• Acute hydrocarbons toxicity usually affects three main target organs: the lungs,
the heart, and the central nervous system (CNS).
• Most ingestions of hydrocarbons do not lead to serious systemic toxicity but
localized gastrointestinal symptoms such as abdominal pain, vomiting, and
diarrhea may occur. Exceptions include halogenated or aromatic hydrocarbons,
hydrocarbons containing metals or pesticides.
• Despite the fact that there are thousands of different types of hydrocarbons,
their potential for acute toxicity depends on just a few physical properties:
• Viscosity
• Volatility
• Surface tension
• Chemical side chains or substitution
• Lipophilicity
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Viscosity
• The capacity to resist flow or change.
• Low viscosity allows a substance to spread rapidly,
and low-viscosity hydrocarbons spread easily into
the airway and lungs (furniture polish, gasoline, and
lamp oil, have the highest potential risk of
aspiration).
• Lubricants and mineral oil, conversely, have high
viscosity and low toxicity potential.
Surface tension
• The capacity for a liquid to adhere to a surface.
• Low surface tension, like low viscosity, enables a
substance (eg, turpentine) to disperse easily and
may lead to pulmonary toxicity.
Volatility
• A measure of a liquid’s ability to evaporate to
a gas or vapor.
• Hydrocarbons with high volatility can displace
alveolar oxygen and cause hypoxia.
• Example of high volatility hydrocarbon 
butane and propane
Chemical side chains or substitutions
• Often increase potential toxicity.
• Metals (eg, arsenic), halogens (eg, the
chloride ions in carbon tetrachloride), and
those found on aromatic structures (eg, the
CH3 group in toluene).
Lipophilicity
• Can enhance blood brain barrier penetration
resulting in CNS effects.
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Pulmonary pathophysiology
• Fatalities  after ingestion usually occur with accompanying aspiration.
• Hydrocarbons penetrate into the lower airways  producing bronchospasm and
direct injury to pulmonary alveoli and capillaries  leading to an inflammatory
response and pneumonitis.
• Hydrocarbons also impair surfactant lipid function, leading to alveolar instability
and collapse  decreased compliance, and impaired gas exchange  lead to
alveolar dysfunction, ventilation-perfusion mismatch, and hypoxemia 
respiratory failure.
• Lipoid pneumonia can also rarely develop
after hydrocarbons coalesce in alveoli and
become encapsulated by fibrous tissue. This
has been reported in adults siphoning
gasoline and from fire-eating performances,
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 CNS pathophysiology
• More than 50% of patients who abuse toluene for
• Most inhalant forms of hydrocarbons cause more than 10 years will have cerebral cortical atrophy
CNS depression. with histologic changes that include loss of neurons,
• Inhalation of these substances avoids hepatic diffuse gliosis, and axonal degeneration
first-pass metabolism and generates high
concentrations in the CNS.
• After respiratory exposure  hydrocarbons
passively diffuse through the pulmonary
alveolus  absorbed in blood and tissues 
cross the blood brain barrier.
• With an isolated single exposure  usually
have a rapid onset of intoxication and short
duration of effect.
• Chronic use of inhaled hydrocarbons can
cause severe abnormalities in nervous system
function, which include memory, attention
and judgment deficits, peripheral neuropathy,
cerebellar degeneration, neuropsychiatric
disorders, chronic encephalopathy, and
dementia.
Rosen’s Emergency Medicine. 2017
Cardiac pathophysiology
• Hydrocarbons can precipitate sudden death, usually in the setting of intentional inhalation.
• These compounds are thought to produce myocardial sensitization to endogenous and exogenous
catecholamines by inhibition of calcium signaling  precipitates ventricular dysrhythmias and myocardial
dysfunction.
• Cardiac dysrhythmia occurs disproportionately among those using halogenated and aromatic hydrocarbons
(eg, difluoroethane).
• Prolonged use can lead to cardiac structural damage and may impede normal function
Other organ systems
• Toluene (induced renal tubular acidosis), benzene (induced bone marrow toxicity and leukemia), methylene
chloride (induced carbon monoxide poisoning), and chlorinated hydrocarbon (induced centrilobular hepatic
necrosis), and renal failure.
• Direct skin exposure of certain hydrocarbons  cause defatting dermatitis, allergic dermatitis, or chemical
burns.
• Intentional intravenous injection of hydrocarbons (kerosene)  led to both localized caustic and necrotic
effects, and systemic effects including renal or hepatic toxicity, systemic inflammatory response syndrome
(SIRS), hemolysis, seizures, pulmonary injury, cardiovascular toxicity, and death.
• Huffing lead to localized increased vascular permeability, which can lead to angioedema, or localized
frostbite when refrigerant is used.
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Rosen’s Emergency Medicine. 2017
Tintinalli’s Emergency Medicine Manual 2018
Other sign & symptoms
• Change in mental status  can be a manifestation of hypoxia or hypercapnia, but it is also
a direct effect of the hydrocarbon itself.
• In extreme cases, patients may have respiratory failure  requiring prehospital intubation.
• Various additives or solutes can produce symptoms independently (eg, seizures from
camphorated hydrocarbons, cyanosis from nitrite-induced methemoglobinemia, or
delayed carbon monoxide poisoning from methylene chloride).
• Have the distinctive odor associated with organic hydrocarbons.
• A characteristic coloration from spray paint (usually silver or gold as these paint colors
require higher concentrations of hydrocarbon) may be present over the mouth and nose.
• Localized angioedema may occur, resulting in a “glue-sniffer’s rash”
• Symptoms of CNS intoxication include euphoria, agitation, hallucinations, confusion, or
bizzare behavior  may progress to CNS depression and seizures.
• Can be asymptomatic or have transient nonspecific symptoms, such as headache,
dizziness, or nausea.

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DD
• CNS depressant (ethanol dan sedative-hypnotics)
• Hypoglycemia
• Imbalance electrolyte
• trauma
• pulmonary irritants
• Intoksikasi organofosfat, salisilat, dan paraquat
• Pneumonia virus/ bakteri

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Diagnosis
• The diagnosis is usually self-evident, supported by history of exposure
and chemical odor.
• CHAMP  a long-standing mnemonic used to help identify
hydrocarbons and their additives with systemic toxicity

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• Cardiac rhythm monitoring and an ECG  indicated in symptomatic patients and patients
who ingest halogenated hydrocarbons, dysrhythmias, syncope, or hemodynamic
instability.
• Chest radiograph  indicated in a symptomatic patient after hydrocarbon aspiration.
Chest radiography is not required in asymptomatic patients.
• Electrolytes, complete blood count, and liver function tests  to assess for renal tubular
acidosis, hypokalemia, bone marrow, or liver injury caused by various hydrocarbons.
• Obtain hepatic function studies, serum ammonia, and prothrombin time in patients who
ingest or inhale halogenated hydrocarbons.
• CBC is indicated if anemia, bleeding disorder, hemolysis, or leukemia is considered.
• Measure carboxyhemoglobin level in patients with exposure to methylene chloride;
repeat measurements may be necessary.
• Determination of methemoglobin level is indicated in patients with exposure to
hydrocarbons containing amine functional groups.
• Abdominal radiographs may show evidence of ingestion of chlorinated hydrocarbons such
as CCl4 or chloroform because of the radiopaque nature of polyhalogenated substances.
Rosen’s Emergency Medicine. 2017
Tintinalli’s Emergency Medicine Manual 2018
Rosen’s Emergency Medicine. 2017
Tintinalli’s Emergency Medicine Manual 2018