Case 21 – A Little Oil Goes a Long Way

Case #21 – A Little Oil Goes a Long Way
Author: Tara Kamath, MD
Peer Reviewer: Michael Christian, MD

A 3-year old girl, Lucy, is brought in by her mother for accidental ingestion. The mother states that she was folding laundry, while Lucy was playing in the other room. Lucy had opened up a box in the closet and found a tiki torch. The mother thought that she may have drunk some of the torch oil, so she decided to give Lucy Syrup of Ipecac to induce vomiting and then bring her to the ED. Lucy vomited what the mother thought was all of the torch oil prior to leaving the house. Shortly after, she had a coughing fit, followed by noisy breathing and grunting and the mother states that her mouth looked “blue”.

On exam, the patient is obtunded. She is tachypneic and using accessory muscles to breathe.

Vitals: Temp: 101.0, HR: 150, BP: 80/40, RR: 40, O2 Sat: 88% on RA

What toxicity is of main concern in the clinical scenario described above?
Why is the patient presenting with the symptoms described above?
What is the appropriate initial management of this patient?
What further work-up could be considered?
What are other common means of HC exposure?
What are the indications for admission?

References:

Hunter L, Gordge L, Dargan PI, et al. Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review. Br J Clin Pharmacol. 2011 Jul;72(1):18-26.

Khalade A, Jaakkola MS, Pukkala E, et al. Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis. Environ Health. 2010 Jun 28;9:31.

Lubman DI, Yücel M, Lawrence AJ. Inhalant abuse among adolescents: neurobiological considerations. Br J Pharmacol. 2008 May;154(2):316-26.

Yücel M, Takagi M, Walterfang M, et al. Toluene misuse and long-term harms: a systematic review of the neuropsychological and neuroimaging literature. Neurosci Biobehav Rev. 2008 Jul;32(5):910-26.

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