2-Xylene

CAS RN: 95-47-6

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Patients with mild to moderate toxicity should do well with standard decontamination and good supportive care. The most common exposure from xylene is from inhalation; removal of patient to fresh air and supportive treatment of systemic symptoms should result in complete recovery in most patients.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) In patients with severe toxicity, patients may require more aggressive respiratory support, including intubation. In patients with hydrocarbon pulmonary aspiration, there is some evidence for the use of an artificial surfactant. Cardiac dysrhythmias can be treated with standard ACLS protocols; epinephrine and other sympathomimetics should be avoided as it may potentiate ventricular dysrhythmias.
    • 2) INHALATION: Move patient to fresh air and monitor for respiratory distress. Administer oxygen and assist ventilation as needed. For patients with bronchospasm, give inhaled beta 2 agonists or corticosteroids as needed. Monitor fluid and electrolyte status. If patients develop dysrhythmias, treat with standard ACLS medications; epinephrine and other sympathomimetics should be avoided as it may potentiate ventricular dysrhythmias.
    • 3) DERMAL: Remove contaminated clothing and wash exposed area thoroughly with soap and water. Barrier creams, protective gloves, and topical steroids may be required to prevent and treat dermatitis symptoms. Treat systemic effects as needed.
    • 4) OCULAR: Irrigate exposed eyes with copious amounts of room temperature water or saline for at least 15 minutes. If irritation, pain, swelling, lacrimation or photophobia persists, a careful ophthalmologic exam, including slit lamp, should be performed.
    • 5) PARENTERAL: Parenteral exposure to xylene is extremely rare; supportive care of resulting symptoms is the mainstay of treatment.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: GI decontamination is not indicated due to the potential for aspiration. Remove contaminated clothing and wash exposed areas with soap and water. Irrigate exposed eyes with normal saline or water for at least 15 minutes.
    • 2) HOSPITAL: GI decontamination is not indicated due to the potential for aspiration. Remove contaminated clothing and wash exposed areas with soap and water. Irrigate exposed eyes with normal saline or water for at least 15 minutes.
  • D) AIRWAY MANAGEMENT
    • 1) Airway management can be an issue for patients with severe respiratory distress or CNS depression, so severe exposure may require early intubation.
  • E) ANTIDOTE
    • 1) There is no specific antidote for xylene exposure.
  • F) ENHANCED ELIMINATION
    • 1) There is no evidence for the use of dialysis, hemoperfusion, urinary alkalinization or multiple dose activated charcoal for xylene exposure. Hemodialysis or hemoperfusion is unlikely to be helpful, as peak blood concentrations of xylene occur very quickly after exposure and the xylene quickly redistributes throughout the body.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Asymptomatic patients with inadvertent ingestions of small quantities of hydrocarbons can remain at home. Eye and skin exposures with only minor irritation can be managed at home after washing or irrigation.
    • 2) OBSERVATION CRITERIA: Any patient with symptoms greater than minor irritation, and any deliberate exposure should be sent to a healthcare facility for evaluation and treatment.
    • 3) ADMISSION CRITERIA: Patients who remain symptomatic should be admitted until they are clearly improving or asymptomatic. Patients with significant CNS depression, dysrhythmias, or pulmonary toxicity should be admitted to an ICU.
    • 4) CONSULT CRITERIA: Consult a medical toxicologist or poison center for patients with significant symptoms. Consult a pulmonologist or intensivist for patients with significant pulmonary toxicity.
  • H) PITFALLS
    • 1) Epinephrine and other sympathomimetics may precipitate refractory dysrhythmias.
  • I) TOXICOKINETICS
    • 1) Xylene is rapidly absorbed following inhalation (60% absorbed, peak concentrations 15 to 30 min) or ingestion (peak concentration 1 to 2 hours). It is less well absorbed through intact skin. The main metabolic pathway is through the cytochrome p450-dependent monooxygenase system to the corresponding 0-, m-, or p-toluic acid. The corresponding toluic acid is then excreted in the form of a glycine conjugate as 0-, m- or p-methyl hippuric acid. Approximately, 72% to 95% of absorbed xylene is excreted in the urine within 18 hours as hippuric acid. The initial half-life in blood is 0.5 to 1 hour while the terminal half-life is 20 to 30 hours.
  • J) PREDISPOSING CONDITIONS
    • 1) Patients at the extremes of age or associated comorbid conditions (such as asthma or chronic obstructive pulmonary disease) may be more sensitive to xylene exposures.
  • K) DIFFERENTIAL DIAGNOSIS
    • 1) A toluene ingestion can appear similar, but is usually more severe. Other hydrocarbon exposures may share similar features of a xylene exposure.
Find more information on this substance at: PubChem, PubMed