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Hydrocarbon poisoning: symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Hydrocarbon poisoning occurs by ingestion or inhalation. Ingestion is more common in children <5 years and may cause aspiration pneumonitis. Inhalation, more common in adolescents, may result in ventricular fibrillation, usually without prior symptoms. The diagnosis of pneumonitis is made clinically, with chest radiography and oximetry. Gastric emptying is contraindicated due to the risk of aspiration. Treatment is supportive.
Ingestion of hydrocarbons such as petroleum distillates (eg, gasoline, kerosene, mineral oil, lamp oil, solvents) causes minimal systemic effects but may cause severe aspiration pneumonitis. The degree of toxicity depends largely on viscosity, measured in Saybolt universal seconds (SUS). Low-viscosity liquid hydrocarbons (SUS < 60), such as gasoline and mineral oil, can be rapidly distributed over a wide area and are more likely to cause respiratory pneumonitis than hydrocarbons with SUS > 60, such as tar. Hydrocarbons ingested in large quantities may cause CNS or liver toxicity as a result of systemic absorption, with halogenated hydrocarbons (eg, carbon tetrachloride, trichloroethylene) causing toxicity.
Inhalation of halogenated hydrocarbons (eg, paints, solvents, cleaning sprays, gasoline, fluorocarbons used as refrigerants or aerosol propellants) is common among adolescents. It can cause euphoria and mental status changes and sensitizes the heart to endogenous catecholamines. It can result in fatal ventricular arrhythmias, which typically develop without prodromal palpitations or other warning symptoms, often when the patient is startled or flees.
[ Symptoms of hydrocarbon poisoning
After ingestion of even very small amounts of liquid hydrocarbon, patients initially cough, choke, and may vomit. Young children develop cyanosis, respiratory arrest, and persistent cough. Older school-aged children and adults may report a burning sensation in the stomach. Aspiration pneumonitis causes hypoxia and respiratory distress syndrome. Symptoms of pneumonitis may develop several hours before the formation of infiltrates visible on radiographs. Significant systemic absorption, especially of halogenated hydrocarbons, may cause altered consciousness, seizures, and coma. Nonfatal pneumonitis usually resolves within a week. Recovery from mineral or lamp oil poisoning usually occurs within 5 to 6 weeks. Arrhythmias usually do not recur after elimination of the cause.
If the patient is not well enough to take a history, a suspected odor from the breath and clothing or the presence of a hydrocarbon container nearby may be helpful. Paint residue on the hands or around the mouth may suggest paint sniffing. The diagnosis of aspiration pneumonitis is made clinically, with chest radiography and oximetry performed approximately 6 hours after the poisoning or sooner if symptoms are severe. Blood gas measurements are performed if respiratory failure is suspected.
Treatment of hydrocarbon poisoning
All contaminated clothing is removed and the skin is washed.
Caution: Gastric emptying, which increases the risk of aspiration, is contraindicated.
Activated carbon is not recommended. Patients without aspiration pneumonitis and other symptoms can be discharged within 4-6 hours, otherwise hospitalization is indicated. Treatment is supportive, antibiotics and glucocorticoids are not indicated.