Turpentine

CAS RN: 8006-64-2

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) INGESTION: Treatment is symptomatic and supportive. Monitor vital signs, mental status and respiratory function. Monitor fluids and electrolytes if the patient develops significant vomiting and/or diarrhea. Treat with IV fluids as needed. Following a significant exposure, monitor for evidence of pulmonary aspiration. INHALATION: Immediately remove the patient from the source of exposure. Symptoms often improve following removal. Closely monitor respiratory function, provide oxygen and symptomatic and supportive care. DERMAL: After assuring that the patient is medically stable, remove contaminated clothing and wash exposed skin with soap and water.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) RESPIRATORY DISTRESS: Orotracheal intubation for airway protection should be performed early if a patient exhibits respiratory distress. Administer oxygen. Consider the use of a surfactant. Endotracheal instillation of 2 doses of 80 mL/m(
    • 2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality in one study. RESPIRATORY FAILURE: Partial liquid ventilation, high frequency jet ventilation, extracorporeal membrane oxygenation (ECMO) and high frequency chest wall oscillation have all been used with apparent success in cases of severe hydrocarbon pneumonitis. SEIZURES: Following a large ingestion of turpentine, seizures, excitement and coma may develop. Initially treat seizures with benzodiazepines. OTHER: Prophylactic antibiotics and steroids are of no proven benefit following hydrocarbon pneumonitis. Monitor and treat significant dysrhythmias.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: GI decontamination is not recommended because of the risk of aspiration. Activated charcoal is generally NOT indicated OR has limited utility as it may cause vomiting and subsequent aspiration. Remove contaminated clothing and wash exposed skin with soap and water.
    • 2) HOSPITAL: Studies fail to show if gastric emptying improves outcomes in patients with oral hydrocarbon ingestions. If a patient has ingested a large amount of a hydrocarbon that causes significant systemic toxicity shortly before presentation, it is reasonable to insert a small nasogastric tube and aspirate gastric contents. However, it should be reserved for patients with significant toxicity (ie, lethargy, coma, or seizures). Activated charcoal is generally NOT indicated OR has limited utility as it may cause vomiting and subsequent aspiration.
  • D) AIRWAY MANAGEMENT
    • 1) Airway support is unlikely to be necessary following a minor or taste ingestion. However, perform orotracheal intubation to protect airway early in patients with severe intoxication (coma, dysrhythmias, respiratory distress).
  • E) ANTIDOTE
    • 1) There is no known antidote.
  • F) COMA
    • 1) Treatment is symptomatic and supportive. Perform orotracheal intubation to protect airway. Assess oxygenation, evaluate for hypoglycemia, and consider naloxone if coingestants are possible.
  • G) TACHYCARDIA
    • 1) Tachycardia may occur from a combination of agitation and catecholamine release. Treat with IV fluids and benzodiazepine sedation if agitation is prominent.
  • H) CONDUCTION DISORDER OF THE HEART
    • 1) Initiate ACLS protocols. Some solvents appear to sensitize the myocardium to catecholamines. Epinephrine and other sympathomimetics should be used with caution as ventricular dysrhythmias may be precipitated.
  • I) ENHANCED ELIMINATION
    • 1) Hemodialysis and hemoperfusion are not of value.
  • J) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Asymptomatic patients with inadvertent exposures may be monitored at home, with particular attention to the development of any respiratory symptoms. Patients who develop symptoms during home monitoring should be referred to a medical facility.
    • 2) OBSERVATION CRITERIA: Patients with deliberate ingestions and symptomatic patients should be sent to a health care facility for observation for 6 to 8 hours. Although patients can develop a delayed pneumonitis, they are unlikely to do so if they have been completely asymptomatic during that time period. Obtain a mental health consult as appropriate.
      • a) Patients with a deliberate ingestion, no initial symptoms and a normal chest x-ray obtained at least 6 hours after ingestion and who remain asymptomatic throughout the observation period (6 hours) can be safely discharged.
    • 3) ADMISSION CRITERIA: Patients with significant persistent central nervous system toxicity (somnolence, delirium), or respiratory symptoms of cough or tachypnea should be admitted. Patients with coma, dysrhythmias, or respiratory distress should be admitted to an intensive care setting.
    • 4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing patients with severe toxicity (ie, dysrhythmias, coma or respiratory distress), or in whom the diagnosis is not clear.
0.4.4 EYE EXPOSURE
  • 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.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 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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