[Acute phenol poisoning]

Phenol (carbolic acid) is one of the oldest antiseptic agents. Currently it is used as a disinfectant, chemical intermediate and nail cauterizer. Phenol is a general protoplasmic poison (denatured protein) with corrosive local effects. Phenol derivates are less toxic than pure phenol. The lethal dose is between 3 to 30 g, but may be as little as 1 g. Phenol is well absorbed by inhalation, dermal application, and ingestion. MANIFESTATIONS OF ACUTE POISONING: Local manifestations. Dermal exposure produces lesions which are initially painless white patches and later turn erythematous and finally brown. Phenol produces mucosal burns and coagulum. They cause eye irritation and corneal damage. When ingested, it causes extensive local corrosions, pain, nausea, vomiting, sweating, and diarrhea. Severe gastrointestinal burns are uncommon and strictures are rare. Inhalation produces respiratory tract irritation and pneumonia. Systemic manifestations develop after 5 to 30 minutes postingestion or post dermal application, and may produce nausea, vomiting, lethargy or coma, hypotension, tachycardia or bradycardia, dysrhythmias, seizures, acidosis, hemolysis, methemoglobinemia, and shock.

Phenol poisoning requires immediate medical evaluation, in cases of significant phenol ingestion (more than 1 g for adults or 50 mg for infants) or symptomatic intoxication. It is necessary to establish and maintain vital functions and establish vascular access. Treatment includes the following: shock (fluids and dopamine), arrhythmias (lidocaine) and convulsions (diazepam). Health personnel should use gowns and rubber gloves. Inhalation of 100% oxygen is recommended. Intubate and assisted ventilation might be necessary. Metabolic acidosis should be managed by 1 to 2 mEq/kg of sodium bicarbonate. Methemoglobinemia should be treated if greater than 30%, or in cases of respiratory distress, with methylene blue 1 to 2 mg/kg of 1% solution, slowly i.v. If phenol is ingested, avoid emesis, alcohol and oral mineral oil and dilution, because they may increase absorption. Gastric lavage is usually not recommended. Immediate administration of olive oil and activated charcoal by small bore nasogastric tube is necessary.

Apart from the abovementioned, immediately decontaminate the skin with copious amounts of water followed by undiluted polyethylene glycol. Wash the area thoroughly with soap and water after treatment. Immediately decontaminate the eyes with copious amounts of tepid water for at least 15 minutes. Follow up examination using fluorescein stain of eyes for corneal abrasion is recommended