Phenol poisoning

Nowadays, phenol is used quite widely, so phenol poisoning happens quite often. Such intoxication is dangerous and can lead to the death of the victim. That is why every person should know about the main signs of the toxic effects of phenol and the actions that must be taken in an emergency.

Epidemiology

Phenol is a white crystal with a distinctive odor. The substance belongs to a number of compounds of the second category of danger, with a conditionally non-hazardous daily dose of up to 0.6 mg/kilogram. The US National Poison Data System reports about 1,000 calls per year related to phenol exposure, about 90% of which are unintentional. [ 1 ], [ 2 ]

Fatalities can occur if a victim inhales a mixture with a concentration exceeding 3.7 mg per liter.

The lethal amount when taken internally is 1-10 g.

Chronic phenol poisoning develops as a result of regular exposure to areas with concentrations of the substance in the air ranging from 0.02 to 2.58 mg/l.

Most often, workers involved in the production of plastic and plastic products, as well as nylon and epoxy resin, are poisoned. A certain amount of the toxic agent can enter the body of medical personnel, as well as people who abuse smoking.

Causes phenol poisoning

The greatest cases of phenol poisoning are recorded during industrial accidents. The higher the concentration of the toxic agent, the more severe the intoxication becomes.

The toxic substance can enter the human body transdermally (through the skin) or by inhalation (by breathing in air). The most common causes of phenol intoxication are: [ 3 ]

• Drinking water containing phenol. The substance can enter a body of water when waste from processing plants is discharged. Chronic phenol poisoning develops with periodic consumption of such water.
• Consumption of food products processed with phenol. Vegetable crops, for example, can be processed with compounds of this substance. And when they are eaten, the toxic agent ends up in the body, causing intoxication.
• Fire. Phenol enters the respiratory tract during the inhalation of smoky air. Smoke that forms as a result of burning chipboard and plastic is especially dangerous. Other smoke components such as hydrocyanic acid, ammonia, phosgene, carbon dioxide, sulfur dioxide, etc. also increase phenol poisoning. [ 4 ]
• Medical antiseptics. Phenol compounds and, in particular, carbolic acid, were used not so long ago to treat skin. When treating large skin surfaces, poisoning occurred in some cases. Currently, the toxicity of such solutions has been revealed, so they are prohibited for use in medicine and cosmetology.
• Work in woodworking industries, chemical industry enterprises, in agriculture. [ 5 ]

Risk factors

• Professional activity: work in phenolic plants and enterprises producing plastics and plastic elements.
• Alcoholism, substance abuse, drug addiction.
• Stressful living conditions, domestic problems.
• Mental illnesses.
• Accidents, fires, disasters.
• Self-medication, incorrect and illiterate use of medications, including those for external use.
• Improper storage of chemicals and medicines with open access for children.
• Regular use of fertilizers and chemicals.
• Consumption of water and agricultural products from unverified sources.

Pathogenesis

Phenol poisoning occurs in different ways, depending on the routes of toxin entry into the body, the regularity or scale of exposure, etc. If a person has to frequently inhale toxic vapors, internal pathology with inflammatory changes in organs develops. Vessels become excessively permeable, hemorrhages appear.

The pulmonary system is affected faster than other organs, a little later – the liver, renal pelvis. Diagnostic studies reveal protein in the urine, acid-base imbalance. Last of all, changes occur in the cardiac tissue and spleen. [ 6 ]

When inhaling phenol vapors, the upper respiratory tract swells, the mucous membrane becomes hyperemic and loose. This leads to obstructive disorders, which manifests itself in symptoms of respiratory failure. In severe phenol poisoning, toxic pulmonary edema develops, the victim experiences convulsive syndrome, and coordination is impaired. [ 7 ]

When phenolic compounds come into contact with the skin, signs similar to a chemical burn appear. In this case, the determining factor is not so much the concentration of the substance as the duration of its presence on the skin. There are known cases when a weakly concentrated 2% solution led to the formation of gangrene within a few hours. Solutions with a high concentration of about 75% cause immediate tissue damage.

If the solution gets into the digestive tract, an ulcerative process and an inflammatory reaction are formed. The probability of internal bleeding increases significantly.

Symptoms phenol poisoning

How to recognize phenol poisoning in a person? The fact is that the first signs can be different, depending on the way the toxic agent enters the body. [ 8 ]

Phenol vapor poisoning is accompanied by the following symptoms:

• feeling of fatigue;
• dizziness, headaches;
• state of excitement;
• excessive salivation;
• a feeling of irritation in the throat, cough;
• rhythmic perioral movements, the so-called "rabbit syndrome". [ 9 ]

Oral phenol poisoning can be identified by the following signs:

• pupils are dilated;
• there is a specific smell from the oral cavity;
• my throat is sore and scratchy;
• the face turns pale and becomes covered in cold sweat;
• the temperature drops;
• shortness of breath appears;
• interruptions in cardiac activity are noted;
• consciousness is impaired;
• convulsive and comatose states are possible.

Chronic phenol poisoning develops slowly, as a result of systematic intoxication. The following symptoms are detected:

• persistent feeling of fatigue;
• increased sweating;
• migraines;
• periodic attacks of nausea, bowel disturbances;
• local manifestations of allergy;
• irritability, irascibility, neuroses.

Contact phenol poisoning occurs when the toxic agent comes into contact with the skin, which is accompanied by the following symptoms:

• lightening of the skin in the contact area;
• formation of wrinkles;
• redness;
• formation of vesicular rashes;
• in severe cases or if medical assistance is not provided – tissue necrosis.

Repeated exposure of the skin to phenol can result in hyperpigmentation, a blue-black discoloration called chronosis, [ 10 ] or hypopigmentation, causing chemically induced vitiligo. [ 11 ]

Stages

Phenol poisoning is divided into the following damaging stages:

1. The mild stage is accompanied by external intoxication symptoms, such as a burning sensation in the eyes, cough. General condition indicators are normal. Sometimes a number of weakly expressed systemic signs are observed: fatigue, headache, dizziness.
2. The moderate stage is characterized by both local and general symptoms. Consciousness may be impaired, but it is not lost. The general condition suffers, but with timely hospitalization and competent treatment, the patient has every chance of a favorable outcome of intoxication.
3. The severe stage poses a threat to the life of the victim. The functioning of internal organs is significantly disrupted, the acid-base balance is upset, neurotropic pathological signs are noted. If phenol poisoning occurs through inhalation of vapors, the patient experiences loss of consciousness. And when swallowing a toxic solution, symptoms of esophageal and gastric burns are detected. The toxic effect on the skin is manifested by second- or third-degree burns. [ 12 ]

Complications and consequences

When inhaling phenol vapors, a complication such as intoxication alveolar pulmonary edema can develop. It is diagnosed in every second victim with acute signs of poisoning.

Another complication in the form of mechanical suffocation occurs in pediatric patients - mainly in preschoolers, which is explained by the small lumen of the respiratory tract. By the way, the occurrence of asphyxia is not particularly common and can be considered as isolated cases.

A frequent late consequence is pneumonia: it is found in approximately 33% of cases of inhalation poisoning with phenol, and even in other routes of poisoning, provided that pulmonary edema develops.

Internal use of phenolic solutions can lead to gastrointestinal perforation, internal bleeding, but most often to the development of sepsis. A remote consequence may be esophageal stenosis, which requires mandatory surgical intervention due to problems with the passage of food.

Contact poisoning with phenol is complicated by deep tissue necrosis up to purulent necrosis – gangrene. If more than ¼ of the skin surface is destroyed, multiple organ failure may develop. [ 13 ], [ 14 ]

Diagnostics phenol poisoning

If phenol poisoning is suspected, diagnostics should be carried out as quickly as possible in order to begin treatment of the intoxication as soon as possible. Anamnesis, collected from the patient and his environment, for example, from direct witnesses of the incident, plays a huge role. If possible, a consultation with a neurologist, infectious disease specialist and toxicologist is carried out. In hospital conditions, the following diagnostic procedures are performed:

• Laboratory tests: general urine and blood tests. Urine in patients with phenol poisoning is dark, with a phenol concentration of 80 to 90 mg/liter in severe intoxication and 50 to 60 mg/liter in moderate intoxication. What explains the color of urine in phenol poisoning? Dark color indicates the presence of toxic phenol metabolites in the fluid. Blood tests show signs of metabolic acidosis - low pH, bicarbonate deficiency, increased anion gap (more than or equal to 13 mmol/liter). Liver function tests are normal unless the case of particularly severe phenol poisoning.
• Instrumental diagnostics are performed depending on the route of phenol ingestion. Thus, in case of internal use of toxic liquid, fibrogastroduodenoscopy is mandatory to detect erosions, ulcers, mucosal burns, and bleeding. In case of pulmonary edema, fluoroscopy is prescribed: numerous fuzzy shadows, image deformation, dilated vascular network, linear Kerley shadows, and a root form in the form of "butterfly wings" are detected. Blood oxygen saturation decreases to 90%. Instrumental methods are not used to diagnose superficial contact lesions.

In addition, the doctor should measure the victim's blood pressure, pulse rate and quality. Against the background of phenol vapor poisoning, characteristic symptoms such as a hoarse voice and a "barking" cough are noted. [ 15 ]

Differential diagnosis

Differential diagnostics should be carried out with other types of poisoning - for example, other toxic effects are accompanied by similar symptoms. Acid, alkaline, oxidative intoxications are excluded. If a doctor arrives at a home or production site, he or she must question witnesses, examine not only the victim, but also the surrounding environment. A characteristic sign may be a phenolic aroma, for example, from the patient's mouth. This smell resembles water-soluble glue paint, such as gouache.

In general, a diagnosis is made after a full range of diagnostic measures has been carried out.

Treatment phenol poisoning

Mild phenol poisoning can be treated at home, but in the case of moderate to severe toxic effects, hospitalization of the victim is mandatory.

The first thing a poisoned person should do is leave the area contaminated with phenol. He should be taken out into the open air, loosened from tight clothing, and placed in a horizontal position with the head side raised. If the victim has lost consciousness, the foot side of the surface is raised. [ 16 ]

In case of contact burns of the skin with phenol, remove clothing soaked in the toxic liquid and wipe the affected areas with an alcohol solution (regular vodka will also do).

Emergency measures taken by ambulance doctors include intravenous administration of sodium thiosulfate in an amount of up to 10 ml. The pre-hospital stage also includes alkaline inhalations and drinking milk (warm). [ 17 ]

If the phenol solution was taken internally, the patient's stomach must be washed with magnesium oxide or crushed activated carbon, less often - sodium sulfate. The lavage is repeated until the water is completely clear and the phenol smell is eliminated. After this, the victim is given a mixture of raw egg or a full tablespoon of castor oil to drink.

Subsequent treatment is symptomatic. Respiratory failure may require one-time tracheal intubation or conicotomy. In the presence of pulmonary edema, the use of a mask is inappropriate.

In case of shock decrease of arterial pressure indicators, the victim is given Cordiamine, Caffeine, and in case of critical drop, Dopamine, plasma substitutes are administered intravenously. If convulsive syndrome develops, sharp psychoexcitation is observed, then in such a situation, the introduction of Relanium is indicated.

During therapy, the main forced diuresis and massive infusion of fluids are prescribed. Narcotic analgesics are used to relieve severe pain. Antihistamines, anti-inflammatory, antispasmodic, sedative drugs are used according to indications. To prevent the development of inflammatory processes in the lungs, antibiotic therapy is appropriate, mainly with cephalosporin drugs.

Medicines that a doctor may prescribe

Calcium gluconate 10%	Used as an antidote, administered intravenously slowly over 3 minutes. Internal administration of the drug is possible. Use with caution in cases of a tendency to thrombosis, atherosclerosis, and increased blood clotting.
Polyphepan	Taken orally with water. The average daily dosage for an adult is 1/2-1 g per kilogram of weight (divided into three doses). The drug can be administered through a tube. Possible side effects: allergy, constipation.
Legends	The drug ademetionine is used parenterally (usually intravenously), in a daily dosage of up to 1600 mg. Side effects: allergy, sleep disorders, dyspepsia.
Enterosgel	During the first three days after poisoning, take a daily dose of 90 g (for an adult, in three doses). The drug is not prescribed for acute intestinal obstruction.
Activated carbon	Dissolve 10-15 tablets of crushed activated carbon for one dose. The suspension can be used for gastric lavage.

Prevention

To avoid phenol poisoning, it is recommended to follow these rules:

• If you have frequent contact with phenol, you must strictly adhere to safety precautions and have and wear personal protective equipment.
• The use of phenol solutions is possible only with constant ventilation of the room, or in the open air.
• Any products containing phenol, whether disinfectant liquids or fertilizers, may only be used after carefully reading the instructions.
• In case of fires, it is necessary to move as far away from the burning area as possible, avoiding inhalation of smoke and soot.
• When purchasing any plastic items (toys, household items), you need to first evaluate their chemical composition.

If there is evidence of air pollution with phenol vapors, it is necessary to use a gas mask (type A), rubberized clothing, and a chemical protection suit. At the first signs of intoxication or deterioration of health, you should immediately contact a doctor.

Forecast

The prognosis cannot be unambiguous, since it depends on many factors, such as the severity of phenol poisoning, the timeliness of assistance, the general health of the body, the age of the victim, etc. If the toxic dose that enters the body is less than 50% of the lethal dose, then one can expect a successful completion of treatment. [ 18 ], [ 19 ]

The quality of the prognosis is significantly worsened if the patient develops pulmonary edema, multiple organ failure, internal hemorrhages. Phenol poisoning of children under seven years of age is always associated with the risk of complete obstructive tracheal occlusion. Chronic intoxication (for example, in workers in phenol production) can eventually lead to the formation of malignant neoplasms, cardiac insufficiency, and reproductive dysfunction.