Phenol poisoning

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

Epidemiology

Phenol is a white crystals with a specific aroma. The substance belongs to a number of compounds of the second hazard category, with a conditionally non-hazardous daily dosage of up to 0.6 mg / kg. The US National Poison Data System reports about 1,000 calls per year related to phenol exposure, about 90% are unintentional. [1], [2]

A fatal outcome can occur if the victim inhales a mixture with a concentration exceeding 3.7 mg per liter.

The lethal amount for internal use is 1-10 g.

Chronic phenol poisoning develops against the background of regular stay in areas with a concentration of a substance in the air from 0.02 to 2.58 mg / l.

More often than others, workers associated with the production of plastic and products from it, as well as nylon, epoxy, are poisoned. A certain amount of toxic agent can enter the body of medical personnel, as well as people who abuse smoking.

Causes of the phenol poisoning

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

A toxic substance is able to enter the human body transdermally (through the skin) or inhalation (with inhalation of air). The most common causes of phenolic intoxication are: [3]

• Drinking water in which phenol is present. The substance may enter the body of water when draining the waste from processing plants. With the periodic use of such water, chronic phenol poisoning develops.
• Eating phenol-treated foods. The compounds of this substance can be processed, for example, vegetables. And when they are eaten, a toxic agent is in the body, causing intoxication.
• Fire. Phenol enters the respiratory tract while breathing in smoky air. Particularly dangerous is the smoke that is formed as a result of burning chipboard, plastic. Enhanced phenol poisoning and other smoke components, such as hydrocyanic acid, ammonia, phosgene, carbon dioxide, sulfur dioxide, etc. [4]
• Medical antiseptics. Phenol compounds, and in particular carbolic acid, have not so long ago been used to treat skin integuments. When treating large surfaces of the skin in some cases, poisoning occurred. Currently, the toxicity of such solutions is disclosed, therefore, they are prohibited for use in medicine and cosmetology.
• Work in the woodworking industry, in the chemical industry, in agriculture. [5]

Risk factors

• Professional activity, work at phenolic plants and enterprises for the production of plastics and plastic elements.
• Alcoholism, substance abuse, drug addiction.
• Tense living conditions, domestic dysfunction.
• Mental illness.
• Accidents, fires, catastrophes.
• Self-medication, improper and illiterate use of medicines, including for external use.
• Improper storage of chemicals and medicines with open access for children.
• Regular use of fertilizers, chemicals.
• The use of water and agricultural products from unverified sources.

Pathogenesis

Phenol poisoning occurs in different ways, depending on how the toxin enters the body, on the regularity or scale of exposure, etc. If a person often has to inhale poisonous fumes, an internal pathology develops with inflammatory changes in organs. Vessels become excessively permeable, hemorrhages appear.

Faster than other organs, the pulmonary system is affected, a little later - the liver, renal pelvis. Diagnostic tests show protein in the urine, acid-base imbalance. Lastly, changes occur in the heart tissues and spleen. [6]

When inhaling phenol vapor, the upper respiratory tract swells, the mucous membrane becomes hyperemic and loose. This leads to obstructive disorders, which is manifested by symptoms of respiratory failure. With severe phenol poisoning, toxic pulmonary edema develops, the patient has a convulsive syndrome, coordination is disturbed. [7]

When phenolic compounds get on the skin, signs appear similar to a chemical burn. In this case, the determining role is played not so much by the concentration of the substance, but by the duration of its presence on the skin. There are cases when a weakly concentrated 2% solution for several hours led to the formation of gangrene. Solutions of high concentration of about 75% cause instant tissue damage.

If the solution enters the digestive tract, an ulcerative process, an inflammatory reaction, is formed. Significantly increases the likelihood of internal bleeding.

Symptoms of the phenol poisoning

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

Poisoning with phenol vapors is accompanied by the following symptoms:

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

Phenol oral poisoning can be determined by the following symptoms:

• pupils dilated;
• there is a specific smell from the oral cavity;
• perspiration and sore throat;
• the face turns pale, is covered with cold sweat;
• temperature goes down;
• shortness of breath appears;
• interruptions in cardiac activity are noted; 
• consciousness is disturbed;
• possible convulsive, coma.

Chronic phenol poisoning develops slowly due to systematic intoxication. The following symptoms are detected:

• enduring feeling of fatigue;
• increased sweating;
• migraine;
• periodic bouts of nausea, stool disorders;
• local manifestations of allergies;
• irritability, short temper, neurosis.

Contact phenol poisoning occurs when a toxic agent enters the skin, which is accompanied by the following symptoms:

• skin lightening in the contact zone;
• wrinkle formation;
• redness;
• the formation of bubble rashes;
• in severe cases or with failure to provide medical care - tissue necrosis.

Repeated exposure of phenol to the skin can lead to hyperpigmentation, blue-black discoloration called chronosis,  [10] or hypopigmentation, which causes chemically induced vitiligo. [11]

Stages

Phenol poisoning is divided into such damaging stages:

1. The mild stage is accompanied by external intoxication symptoms, such as a feeling of pain in the eyes, coughing. General condition indicators are normal. Sometimes there are a number of mild systemic signs: fatigue, headache, dizziness.
2. The moderate stage is characterized by both local and general symptoms. Consciousness may be impaired, but its loss does not occur. The general condition suffers, but with timely hospitalization and proper treatment, the patient has every chance of a successful outcome of intoxication.
3. Severe stage poses a threat to the life of the victim. Significantly disrupted the work of internal organs, acid-base balance is upset, neurotropic pathological signs are noted. If phenol poisoning occurred when inhaled vapors, then the patient has a loss of consciousness. And when a toxic solution is swallowed, symptoms of an esophageal and gastric burn are detected. Toxic effects on the skin are manifested by second or third degree burns. [12]

Complications and consequences

When inhaled, phenol vapor will burn a complication such as intoxication alveolar pulmonary edema. 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 preschool children, due to the small clearance of the respiratory tract. By the way, the appearance of asphyxia is not particularly common and can be considered as isolated cases.

A frequent long-term consequence is pneumonia: it is found in approximately 33% of phenol inhalation poisonings, and even with other poisoning routes, provided pulmonary edema develops.

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

Contact phenol poisoning is complicated by deep necrosis of tissues up to purulent necrosis - gangrene. If more than ¼ of the skin surface is destroyed, the development of multiple organ failure is possible. [13], [14]

Diagnostics of the phenol poisoning

If phenol poisoning is suspected, the diagnosis should be carried out as soon as possible, so that treatment of intoxication can be started as soon as possible. A huge role is played by the anamnesis, collected from the words of the patient himself and his entourage - for example, from direct witnesses of the incident. If possible, a neurologist, infectious disease specialist and toxicologist are consulted. In stationary conditions, the following diagnostic procedures are performed:

• Laboratory tests: general urine and blood tests. Urine in patients with phenol poisoning is dark, with a concentration of phenol with severe intoxication - from 80 to 90 mg / liter, with moderate intoxication - from 50 to 60 mg / liter. What explains the color of urine in phenol poisoning? A dark color indicates the presence of toxic phenolic metabolites in the fluid. A blood test shows signs of metabolic acidosis - a lowered pH, a hydrocarbonate deficiency, increased anionic divergence (more than or equal to 13 mmol / liter). Indicators of liver tests are normal, if we are not talking about especially severe phenol poisoning.
• Instrumental diagnostics are performed, depending on the route of phenol into the body. So, with the internal use of toxic fluid, fibrogastroduodenoscopy is mandatory to detect erosion, ulcers, burns of the mucosa, and bleeding. With pulmonary edema, fluoroscopy is prescribed: numerous fuzzy shadows, image deformation, an expanded vasculature, linear Curly shadows, a basal shape in the form of "butterfly wings" are found. Blood oxygen saturation is reduced to 90%. For the diagnosis of superficial contact damage, instrumental methods are not used.

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

Differential diagnosis

Differential diagnosis should be carried out with other types of poisoning - for example, other toxic effects are accompanied by similar signs. Excluded acidic, alkaline, oxidative intoxication. If a doctor arrives on a call to a house or to a production site, then he will surely interview witnesses and examine not only the victim, but also the surroundings. A characteristic feature may be a phenolic aroma, for example, from the patient’s oral cavity. This smell resembles a water-soluble adhesive paint, such as gouache.

In general, the diagnosis is made after the entire complex of diagnostic measures.

Treatment of the phenol poisoning

Phenol poisoning of a mild degree is allowed to be treated at home, but with toxic effects with a moderate and severe course, hospitalization of the victim is required.

First of all, the poisoned person must leave the area contaminated with phenol. It should be taken out (taken out) in the open air, loose tight clothing, give it a horizontal position with a raised head side. If the victim lost consciousness, then lift the foot side of the surface. [16]

In case of a contact burn of the skin with phenol, clothes soaked with toxic liquid are removed, the lesions are wiped with an alcohol solution (ordinary vodka is also suitable).

Emergency measures by ambulance doctors consist in the intravenous administration of sodium thiosulfate in an amount of up to 10 ml. The prehospital phase also involves alkaline inhalation, the ingestion of milk (in the form of heat). [17]

If the phenolic solution was taken orally, then the patient must be washed in the stomach with magnesium oxide or powdered activated carbon, less often sodium sulfate. The washing is repeated until the water is completely purified and the phenolic odor is eliminated. After that, the victim is given a drink with a raw egg chatter or a full tablespoon of castor oil.

Subsequent treatment is symptomatic. Impaired respiratory function may require a single tracheal intubation or conicotomy. With pulmonary edema, the use of a mask is impractical.

With a shock lowering of blood pressure, the patient is given Cordiamin, Caffeine, and with a critical drop, Dopamine and plasma substitutes are administered dropwise. If convulsive syndrome develops, a sharp psycho-excitation is observed, then in this situation, the introduction of Relanium is indicated.

During therapy, the main forced diuresis, massive fluid infusion, is prescribed. For the relief of severe pain, narcotic analgesics are used. According to indications, antihistamines, anti-inflammatory, antispasmodic, sedatives are used. To prevent the development of inflammatory processes in the lungs, antibiotic therapy is mainly appropriate with cephalosporin medications.

Medications Your Doctor May Prescribe

Calcium Gluconate 10%	Used as an antidote, administered intravenously slowly, for 3 minutes. Possible internal administration of the drug. Use with caution with a tendency to thrombosis, with atherosclerosis, increased blood coagulation.
Polyfepan	Take orally with water. The average daily dosage for an adult is 1 / 2-1 g per kilogram of weight (divided into three doses). Means can be entered through a probe. Possible side effects: allergies, constipation.
Of legends	Ademethionine is used parenterally (often intravenously), in a daily dosage of up to 1600 mg. Side effects: allergies, sleep disturbances, 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	10-15 tablets of crushed activated carbon are bred for one dose. Suspension can be used for gastric lavage.

Prevention

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

• With frequent contact with phenol, it is necessary to strictly adhere to safety precautions, carry 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 means with phenol, whether it is disinfectant liquids or fertilizers, is allowed to be used only after carefully reading the instructions.
• In case of fires, it is necessary to move away from the burning zone as far as possible, preventing the inhalation of smoke and soot.
• When buying any plastic items (toys, household accessories), you need to first evaluate their chemical composition.

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

Forecast

The prognosis cannot be unambiguous, because it depends on many factors, such as the severity of phenol poisoning, the timeliness of care, the particular state of the body’s health, the age of the victim, etc. If the toxic dose that has got into the body is less than 50% of the lethal one, then we can count on successful completion of treatment. [18],  [19], 

The prognosis quality deteriorates significantly if the patient develops pulmonary edema, multiple organ failure, internal hemorrhage. Phenol poisoning of children under the age of seven is always associated with the danger of complete obstructive closure of the trachea. Chronic intoxication (for example, among phenol production workers) over time can lead to the formation of malignant neoplasms, cardiac insufficiency, as well as impaired reproductive function.