CAS RN:107-87-9

Treatment Overview

    • 1) The mainstay of management of mild to moderate toxicity is decontamination and supportive care.
    • 1) For severe toxicity, treatment should be targeted towards symptoms. Recent ingestion of large amounts of ketones may benefit from orogastric aspiration. Patients with obtundation, seizures, significant altered mental status, or severe respiratory symptoms require early intubation. Metabolic acidosis can be treated with bicarbonate therapy, and severely ill patients may benefit from dialysis. INHALATION EXPOSURE: Administer oxygen and assist ventilation as needed. Inhaled beta-2 agonists and oral or parenteral corticosteroids can be used to treat bronchospasm. DERMAL EXPOSURE: Remove contaminated clothing and wash exposed areas thoroughly with soap and water. Treat dermal irritation or burns with standard topical therapy. Those experiencing a hypersensitivity reaction may require treatment with topical or systemic antihistamines and/or corticosteroids. EYE EXPOSURE: Irrigate eyes with copious amounts of room temperature water for at least 15 minutes. If irritation, pain, swelling, lacrimation or photophobia persist, perform a slit lamp examination.
    • 1) PREHOSPITAL: GI decontamination is generally not recommended because of the risk of aspiration. Remove contaminated clothing and wash exposed skin. Irrigate exposed eyes.
    • 2) HOSPITAL: There is no evidence for the use of activated charcoal or gastric lavage. Orogastric aspiration can be considered for large or massive ingestions that have occurred recently. Remove contaminated clothing and wash exposed skin. Irrigate exposed eyes.
    • 1) In patients who develop severe respiratory issues or CNS depression, early intubation should be performed.
    • 1) None
    • 1) Although there are no specific cases of dialysis use for removing ketones, there is significant renal elimination of parent ketones and/or their corresponding alcohol or glucuronides conjugates.
    • 1) HOME CRITERIA: Patients with unintentional exposures with minimal to no symptoms may be managed at home.
    • 2) OBSERVATION CRITERIA: Patients should be sent do a healthcare facility if their exposure to ketones was in a self-harm attempt or if they were symptomatic. They should be observed for 4 to 6 hours and be clearly improving or asymptomatic prior to discharge.
    • 3) ADMISSION CRITERIA: Patients with severe symptoms or those who are getting worse after an observation period of 4 or 6 hours should be admitted to the hospital. Depending on the severity of their symptoms, ICU admission may be warranted (eg, intubated patients). Patients should not be discharged until they are clearly improving or asymptomatic.
    • 4) CONSULT CRITERIA: Consult a medical toxicologist or poison center for patients with severe toxicity in whom the diagnosis is unclear. Physicians who practice occupational medicine may be useful for patients with workplace exposures to ketones. Toxicologists and poison centers are available to help in any cases.
    • 1) Ketones and ketone peroxides are 2 different types of exposures, though mixed exposures may occur. Ketone peroxides are highly reactive and corrosive and management of ketones verus ketone peroxides differ.
    • 1) Rapidly absorbed, minimal protein binding. Most are reduced to the corresponding alcohol and eliminated, in urine and expired air, as glucuronide conjugates. Both methyl-isobutyl ketone and n-hexane and its metabolite, 2-hexanone, are metabolized to 2,5-hexanedione. 2,5-hexanedione is thought to produce the characteristic neuropathy produced by these agents. In a case of a mixed ingestion of acetone, methyl ethyl ketone, and cyclohexanone, the half-life of acetone was 18 hours and the half-life of methyl ethyl ketone was 10 hours. Following inhalation, methyl ethyl ketone has a biphasic elimination curve with an initial half-life of 30 minutes and a terminal half-life of 81 minutes.
    • 1) Other substances that may mimic ketone exposures include other irritant chemicals, other hydrocarbons, or neurotoxic substances.
  • A) INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.
  • A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
    • 1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
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