Phenol poisoning is an acute or chronic intoxication provoked by inhalation of vapors of a substance, its fine dust formed during condensation of vapors, as well as the ingestion of a toxicant on the skin. The symptoms depend on the type of compound. The most common signs are cough, dizziness, burns of the respiratory tract, convulsions. Pathology is diagnosed on the basis of anamnesis and clinical picture. The toxicochemical study is uninformative. Treatment includes treatment of the skin with 40% ethanol, administration of sodium thiosulfate, alkaline inhalations. With oral lesions, gastric lavage with a suspension of activated charcoal is indicated.
ICD 10
T54.0 Toxic effect of corrosive substances. Phenol and its homologues
General information
Phenol is a white crystalline substance with a specific odor. It belongs to compounds of hazard class II. The MPC of its vapors is 0.1 mg / m3, in water — 0.001 mg / l. The conditionally safe daily dose is 0.6 mg/kg. Fatal poisoning occurs when inhaling mixtures that contain more than 3.7 mg of xenobiotic per liter. The lethal dose for oral administration varies from 1 to 10 grams. Regular presence in areas with 0.02/2.58 mg/ liter of phenol in the air leads to chronic damage. The risk group includes workers engaged in the production of plastics, nylon, epoxy resins. Physicians and tobacco smokers are at moderate risk of exotoxicosis.
Causes
Phenol poisoning occurs during accidents at industrial enterprises. Intoxication is difficult due to the high dose of the toxic substance. The poison is delivered transdermally and by inhalation. Lethal disorders develop if 25-50% of the human body surface is in contact with the toxicant. The most dangerous monatomic varieties of the compound (carbolic acid). Polyatomic substances (pyragallol) are less toxic. Other reasons:
- The use of contaminated water. Phenol enters reservoirs in violation of the rules of waste processing by production organizations. There are known cases of dumping toxic substances into drinking reservoirs. People who use such water may experience symptoms of intoxication, usually chronic. Acute lesions are rare.
- Ingestion of food. Vegetables growing in fields contaminated with chemicals have the ability to accumulate harmful components. When eating dishes made using these products, the xenobiotic enters the body, causes signs of intoxication of mild or moderate degree.
- Fires. Phenol poisoning occurs when inhaling smoke generated during the combustion of chipboard, plastics. It is combined with the defeat of other gaseous products: carbon oxide and dioxide, prussic acid, sulfur dioxide, ammonia, phosgene. Signs of suffocation, hypoxia of the hemic type come to the fore.
- Use in medicine. Phenols (carbolic acid) were used until recently as a means of antiseptic skin treatment. When applying the medication to a large area or using high concentrations, poisoning developed. Today, CC is not used for application to the patient’s body due to its potential toxicity.
- Cosmetic procedures. Symptoms of exotoxicosis are noted in women who have undergone a peeling procedure using carbolic acid or its derivatives. Chemical exotoxicoses occur when processing a large surface, as well as due to violation by the cosmetologist of the permissible dosages of the drug.
Pathogenesis
The effect of phenols on the body is multifaceted, it depends on the route of entry of the poison, the time of exposure and the frequency of contact with the toxic substance. With regular inhalation of vapors, pathological fullness of internal organs occurs, their inflammatory infiltration. Areas of hemorrhage form around the vessels. First of all, the lungs are affected, then the liver and kidneys. Proteinuria, metabolic acidosis is detected. The heart and spleen suffer less than other structures.
Acute inhalation poisoning with phenol is characterized by the formation of edema and hyperemia of the upper respiratory tract. Mechanical obstruction is determined, which is accompanied by signs of respiratory insufficiency of varying degrees. Severe cases end in toxic pulmonary edema. There is an initial excitation of the respiratory center, followed by its depression. The neurotropic effect of xenobiotics is manifested by convulsions, impaired coordination.
If carbolic acid gets on the skin, the symptoms of a chemical burn are revealed. Their severity depends not only on the concentration of the solution, but also on the time of its exposure. Even 2-3% of the composition is capable of provoking gangrene if it has not been removed for 2-3 hours. 70-80% of the product burns the tissues almost instantly. When liquid forms of poison or its crystals enter the stomach, ulceration forms, an inflammatory process develops. Bleeding is possible. The picture resembles that of poisoning with cauterizing fluids.
Classification
The division can be carried out according to the type of the poisoning component (monatomic, polyatomic, chlorinated), for reasons that caused phenol poisoning (industrial, alimentary, iatrogenic), along the routes of poison intake (inhalation, oral, transdermal). Classification by severity is considered significant. The following levels of chemical damage are distinguished:
- Easy. Mainly local signs of intoxication. The victims complain of irritation of the eyes, respiratory tract. The general condition is not disturbed. Minor systemic phenomena may be noted: headache, weakness, subjective feeling of lack of air, which is not confirmed by the data of an objective examination.
- Medium. General and local symptoms of the lesion are determined. There are moderate changes in consciousness without its loss. Well-being is significantly impaired, but there is no threat to life until complications develop. Hospitalization is required in the general department of a toxicological hospital.
- Heavy. There are immediate vital risks caused by significant changes in the work of internal systems, metabolic acidosis, and the neurotropic effect of a toxicant. With inhalation lesions, loss of consciousness occurs, with oral lesions, there are signs of a burn of the esophagus and stomach of II-III degree. With a transdermal lesion, similar injuries form on the skin.
Symptoms
Oral poisoning provokes signs such as intense burning in the mouth and throat immediately after consuming the poison, abdominal pain, muscle weakness, skin cyanosis. When taking concentrated solutions, dark smudges are detected on the lips, chin. Later, diarrhea develops, vomiting with an admixture of blood, psychomotor agitation, clonic contraction of the muscles. In severe lesions, central nervous system depression, coma, a critical decrease in blood pressure, centralization of blood circulation and other symptoms of exotoxic shock are detected.
Inhalation injuries are characterized by a clinic of mechanical asphyxia. The patient is pale, scared, covered with sticky cold sweat, restless. There is increased motor activity. On examination – generalized cyanosis, inclusion of auxiliary muscles in the breathing process, fluttering of the wings of the nose. The visible mucous membranes of the mouth and throat are swollen, hyperemic. Common symptoms are a sharp headache, dizziness, impaired coordination, a feeling of suffocation. In severe cases, coma, reflex respiratory arrest, convulsions are observed.
Percutaneous poisoning with phenol leads to a chemical burn. At the point of contact, the skin becomes wrinkled, pale, and after a few days it peels off. The victim complains of a burning sensation, tingling, numbness of the damaged area. When a large area is affected, common phenomena are detected: hemolysis of erythrocytes, an increase in hematocrit, a violation of the function of excretion systems. A short-term increase in body temperature, hyperkinesis, changes in the heart, respiratory apparatus develops.
Chronic intoxication is manifested by nausea in the morning, sweating, decreased muscle tone. There are complaints of mental instability, irritability, insomnia. Some patients have itching and salivation. 95% of the victims report the appearance of a dry cough, especially pronounced during the working day. It is possible to develop anemia, concentric narrowing of the field of vision to red, pain in the epigastric region. 40% of people have a feeling of palpitation, shortness of breath.
Complications
An early complication with a predominant lesion of the respiratory apparatus is considered to be toxic alveolar pulmonary edema. It is detected in 50% of victims with an acute form of the disease. Mechanical asphyxia is usually found in preschool children, due to the small diameter of the airway. Such situations are rare. A common delayed consequence is pneumonia, which is diagnosed in 30-35% of cases of inhalation trauma. It is detected after severe poisoning, accompanied by pulmonal edema.
Against the background of oral administration of phenols, gastrointestinal perforation (2-3%), bleeding (7-10%), septic process (14-15%) may occur. In the later stages of healing, areas of esophageal stenosis form, which makes it difficult to pass solid food and requires surgical correction. Against the background of prolonged tactile contact with phenols, 8-10% of patients develop areas of deep tissue necrosis. Gangrene formation is possible. When more than 25% of the body surface is affected, multiple organ failure develops.
Diagnostics
The diagnosis is made by an ambulance doctor who arrived at the scene. The information obtained during the interview of the victim and witnesses is of great importance. The clinical picture does not always allow us to determine exactly what substance provoked the existing symptoms, confirmation is made in the hospital. An examination by a toxicologist, neurologist is required. In severe forms of pathology, a consultation with a resuscitator is prescribed. The following survey methods are used:
- Physical. The characteristic clinical signs of phenol damage are determined. Blood pressure with mild and moderate degrees is above 140/90, with shock – less than 90/60, in many cases it is not possible to listen to Korotkov’s tones. The pulse is rapid, arrhythmic in 30-32% of situations. The BDD is above 14-15 times/minute. After inhaling phenol, there is hoarseness of voice, barking cough.
- Laboratory. The color of the urine is dark, due to the presence of metabolites of the toxicant. The concentration of phenol in severe pathology is 80-90 mg / l, in moderate varieties – 50-60 mg per liter. In the blood, metabolic acidosis – a decrease in pH, a deficiency of bicarbonates, an increase in the anionic difference ≥13 mmol / L. Liver tests do not go beyond the norm. The exception is extremely severe intoxication.
- Hardware. Poisoning with phenol through the mouth is an indication for EGDS. The presence of burns and ulceration is determined. In case of pulmonary edema, multiple blurry shadows, deformity of the pattern, vasodilation, Curling lines, “butterfly wings” are present on the X-ray image. The saturation index has been reduced to 80-95%. For superficial skin burns, hardware techniques are not used.
Differential diagnosis is performed with intoxication with poisons having a similar effect. It is necessary to exclude damage by acids and other substances of cauterizing action (concentrated alkalis, oxidizers). At the pre-hospital stage, this is done according to the results of a survey of eyewitnesses and an inspection of the scene, by the smell of phenol (resembles gouache) coming from the patient. In the conditions of a medical institution, the results of a comprehensive examination serve as the basis for making a final diagnosis.
Treatment
Intoxication of moderate and severe degree requires hospitalization of the victim. It is permissible to provide outpatient care to patients with mild poisoning. Before the arrival of the doctors, the person should be evacuated from the pollution zone, ensure air flow, unbutton the restraining clothes, lay with the raised head end. If there is a loss of consciousness, you need to lift your legs and lower your head to the same level with the body. Contaminated clothing must be removed, and areas of skin that have come into contact with the poison should be wiped with vodka.
First aid
To bind the toxicant by ambulance crews, sodium thiosulfate is used in a dose of 8-10 ml. The method of administration is intravenous. Alkaline inhalations and warm milk for drinking are recommended for PHS. Oral phenol poisoning is an indication for gastric lavage. As a working solution, a suspension of activated carbon or burnt magnesia is used, sometimes sodium sulfate. The procedure is carried out until clean waters and the smell of xenobiotic disappears, then the patient is given castor oil or raw egg to drink.
Further therapy is carried out taking into account the symptoms. With significant respiratory depression, a single attempt at tracheal intubation is necessary, if it fails, you should proceed to a conicotomy. The installation of a larengeal mask against the background of edema of the respiratory tract is not recommended. A moderate decrease in blood pressure requires an infusion of cordiamine, caffeine, a drop in indicators below 90/60 is an indication for drip administration of dopamine, plasma–substituting solutions. Convulsions and mental agitation are stopped with the help of relanium.
Inpatient treatment
The patient is shown alkaline forced diuresis, volumetric infusion therapy. At the same time, the volume of the injected and withdrawn liquid should be carefully monitored. Anesthesia for burns of the gastrointestinal tract is performed with the help of narcotic analgesics. Skin injuries usually allow the use of over-the-counter painkillers. An infusion of antihistamines, anti-inflammatory, sedative medications, antispasmodics is performed. In order to prevent pneumonia, antibiotics of the cephalosporin group are prescribed.
Surgical methods
They are used for oral and transdermal poisoning. Symptoms of gastric bleeding require emergency medical and diagnostic gastroscopy. During the procedure, the hemorrhagic focus is cauterized with silver nitrate or pricked with adrenaline. If there are signs of perforation, the patient is transported to the operating room for open laparotomy and suturing of injuries. The surgical method of treating URT obstruction is the imposition of a tracheostomy. The operation consists in the formation of an artificial fistula on the trachea, followed by the installation of a breathing tube.
In case of deep skin injuries, the surgeon resects necrotized and infected tissues, performs thorough hemostasis. With the development of gangrene, it may be necessary to remove the injured limb. Patients suffering from esophageal stenosis need bougie, an operation that allows them to restore the patency of the gastrointestinal tract and return the ability to take solid food. Reconstructive interventions are carried out at a later date, after complete healing of burn wounds.
Prognosis and prevention
Phenol poisoning has a favorable prognosis if the received dose of poison does not exceed half of the lethal one. The victim’s chances of life are sharply reduced against the background of pulmonal edema, multiple organ failure, internal bleeding. The risk of complete tracheal obstruction is as high as possible among children under 5-7 years of age. Employees of enterprises who are often in contact with phenol have an increased risk of malignant tumors, heart failure, and infertility.
Prevention includes the use of brand A gas masks when in areas contaminated with phenol vapors. When spraying the aerosol, an additional filter or respirator should be used. Protective clothing is required – rubberized apron, gloves, chemical protection suits. It is unacceptable to treat large skin surfaces with carbolic acid as an antiseptic. It is recommended to eat environmentally friendly products and water. Phenol poisoning and signs of general deterioration of health are a reason to seek medical help.