Respiratory complications of hydrocarbon aspiration

See also: Hydrocarbon ingestion.

Bahceci Erdem S, et al. Pulmonary complications of chemical pneumonía: a case report. Arch Argent Pediatr. 2016 Aug 1;114(4):e245-e248.

Hydrocarbon aspiration (HA) can cause significant lung disease by inducing an inflammatory response, hemorrhagic exudative alveolitis, and loss of surfactant function. The most serious side effect of HA is aspiration pneumonia. Pneumothorax, pneumatocele, acute respiratory distress syndrome (ARDS), pulmonary abscess, bronchopleural fistula, bilateral hemorrhagic pleural effusion and pyopneumothorax were previously reported. Hereby we report a patient hospitalized due to aspiration pneumonia who developed pleurisy and pneumothorax after drinking paint thinner. It is presented as it was seldom reported in children to cause distinct pulmonary complications. Patients with complaints associated withhydrocarbon poisoning must be fully evaluated. They must not be discharged from the hospital early and must be followed for at least 48 hours even if they don’t have respiratory symptoms. It should be kept in mind that severe pulmonary complications can develop in patients with chemical pneumonia.

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Makrygianni EA, et al. Respiratory complications following hydrocarbon aspiration in children. Pediatr Pulmonol. 2016 Jun;51(6):560-9.

Accidental hydrocarbon ingestion may lead to aspiration and chemical pneumonitis in children. In this review article, the clinical course of hydrocarbon pneumonitis, chest radiographic abnormalities, complications, and treatment interventions are summarized. Most children remain asymptomatic and without complications following ingestion of a hydrocarbon. In approximately 15% of ingestions, aspiration pneumonitis occurs and evolves over the first 6-8 hr presenting with fever, tachypnea, hypoxemia, and tachycardia. A symptom zenith is reached within 48 hr followed by progressive improvement. Up to 5% of pneumonitis cases progress rapidly to acute respiratory failure. Chest radiographic abnormalities develop by 4-8 hr after ingestion, but they are not always predictive of clinical pneumonitis. Patients with history of hydrocarbon ingestion should be monitored for 6-8 hr in the emergency department and a chest radiogram should be obtained at the end of the observation period. Spontaneous or induced emesis and gastric lavage have been related to aspiration pneumonitis. Children who are symptomatic are admitted to the hospital for cardiorespiratory status monitoring and supportive care. Approximately 90% of hospitalized patients have a benign clinical course. Increased work of breathing with or without altered sensorium and seizures are indications for admission to the intensive care unit. Hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require mechanical ventilation. Corticosteroids do not seem to offer any benefit and antibiotics are administered in cases of bacterial superinfection. Pneumatoceles may become evident after the first 6-10 days of symptoms on follow-up chest radiograms and they resolve up to 6 months later.

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Sen V, et al. An evaluation of cases of pneumonia that occurred secondary to hydrocarbon exposure in children. Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:9-12.

“The treatment of hydrocarbon pneumonia is aimed at reducing the symptoms [8]. The use of steroids and antibiotics for treatment is still controversial. Experimental and clinical studies in animals and humans have found different results and are inconclusive. Some studies suggest that steroid usage reduces inflammation and the subsequent fibrosis [11]. Corticosteroids may reduce the development of fibrosis [12]. However, it is important to emphasize that steroids can increase the risk of secondary infections. In our study, [18] patients (33.3%) with an oxygen saturation of < 92 who had findings of respiratory failure and who were admitted to the ICU were treated with steroids. The oxygen saturation of [17] patients returned to normal in the first 24 hours of steroid treatment. Moreover, none of the patients treated with steroids had a superinfection.”

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Thalhammer GH, et al. Pneumonitis and pneumatoceles following accidental hydrocarbon aspiration in children. Wien Klin Wochenschr. 2005 Feb;117(4):150-3.

Accidental ingestion and aspiration of hydrocarbons in children are common. Among the various clinical and pathological manifestations of hydrocarbon (HC) poisoning, pneumonitis is the most significant and occurs in up to 40% of children, whereas formation of pneumatoceles is believed to be a rare event. We report two children with HC pneumonitis and pneumatoceles as a reversible complication after ingestion and aspiration of lamp oil with very low viscosity. Patient 1, a 21-month-old boy, started to cough and developed tachypnea, sternal retractions and mild cyanosis immediately after aspiration. Patient 2, a 24-month-old girl, was asymptomatic during the first days after the accident; subsequently, she started to cough and developed fever, dyspnea and chest pain. Chest x-ray and computed tomography revealed multiple patchy infiltrates in both cases; after several days, these confluent infiltrates developed into pneumatoceles. Both children were treated with antibiotics and steroids. They recovered within three and four weeks, respectively, with complete remission of the radiologic abnormalities and had an uneventful follow-up after discharge.

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More PubMed results on treatment of hydrocarbon aspiration.

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