95  Hydrocarbons Ingestion

96 Introduction

Hydrocarbon ingestion remains a significant and preventable cause of childhood poisoning globally, including in Ghana and other parts of sub-Saharan Africa. These substances are commonly found in households, used for cooking, cleaning, transportation, and mechanical activities. Their widespread availability, storage in unlabeled containers, and the natural curiosity of children—especially those under five years—contribute substantially to accidental exposures.

Hydrocarbons are organic compounds consisting entirely of hydrogen and carbon. They vary widely in viscosity, volatility, and chemical structure, all of which influence their toxicity. The primary danger following ingestion is aspiration into the lungs, which can lead to chemical pneumonitis, respiratory distress, and potentially life-threatening complications.

This article reviews the classification of hydrocarbons, mechanism of toxicity, clinical presentation, diagnostic evaluation, management strategies, and preventive measures, with particular emphasis on the local Ghanaian context.

97 Classification of Hydrocarbons

Hydrocarbons can be broadly grouped into categories based on chemical composition and household use. Understanding these classes is crucial in predicting toxicity and guiding management.

97.1 1. Aliphatic Hydrocarbons

These include straight-chain compounds often used as fuels and solvents. Examples:

• Kerosene (commonly used in Ghana for cooking and lighting)
• Petrol (gasoline)
• Diesel
• Mineral oil

These substances have low viscosity and high volatility, making them particularly dangerous because they are easily aspirated.

97.2 2. Aromatic Hydrocarbons

These compounds contain a benzene ring and pose additional systemic toxicity risks.

Examples: - Benzene (industrial solvents) - Toluene - Xylene

Aromatic hydrocarbons can cause central nervous system (CNS) depression, bone marrow suppression, and hepatic injury.

97.3 3. Halogenated Hydrocarbons

These contain halogens such as chlorine or fluorine and are highly toxic.

Examples: - Methylene chloride - Chloroform - Carbon tetrachloride

They can lead to arrhythmias, hepatotoxicity, and severe metabolic acidosis.

97.4 4. Terpenes

These are aromatic compounds derived from plants.

Examples: - Camphor oil - Turpentine

Common in local herbal and household preparations, these can cause CNS depression and seizures in children.

98 Mechanism of Toxicity

The toxicity of hydrocarbons depends on three factors:

98.1 1. Aspiration Potential

This is determined by: - Low viscosity (thin liquids) - High volatility - High surface tension

Kerosene—widely used in Ghana—has low viscosity and high volatility, increasing the risk of aspiration during ingestion or vomiting.

When aspirated, hydrocarbons disrupt pulmonary surfactant, cause alveolar inflammation, and lead to chemical pneumonitis.

98.2 2. Systemic Absorption

Aromatic and halogenated hydrocarbons are readily absorbed through the gastrointestinal tract and lungs. They may cause: - CNS depression - Hepatic and renal injury - Cardiac dysrhythmias (“sensitization of myocardium to catecholamines”)

98.3 3. Direct Local Effects

Hydrocarbons can irritate skin and mucous membranes, leading to: - Coughing - Choking - Sneezing - Vomiting (which increases aspiration risk)

99 Epidemiology and Local Context

In Ghana, hydrocarbon ingestion is most often linked to kerosene and petrol. The widespread use of kerosene in peri-urban and rural households, coupled with storage in drink bottles or open containers, increases the likelihood of accidental ingestion by toddlers.

Studies in West Africa consistently show that: - The highest incidence occurs in children aged 1–3 years. - Male children are slightly more affected. - Most cases follow ingestion from improperly stored fuel.

Because many families initially attempt home interventions—such as inducing vomiting or giving palm oil—aspiration risk is often increased before the child reaches formal care.

100 Clinical Features

The clinical presentation varies depending on the type of hydrocarbon ingested, the amount consumed, and whether aspiration occurred.

100.1 1. Immediate Symptoms from Aspiration

These often develop within minutes to hours:

• Coughing or choking
• Tachypnoea
• Hypoxia
• Wheezing or crackles on auscultation
• Respiratory distress
• Fever (usually after 4–6 hours due to inflammation)

100.2 2. Systemic Effects

More common with aromatic and halogenated hydrocarbons:

• CNS depression (drowsiness, confusion, coma)
• Ataxia
• Seizures (especially with camphor and turpentine)
• Cardiac arrhythmias
• Hepatic dysfunction (carbon tetrachloride)
• Renal impairment

100.3 3. Gastrointestinal Symptoms

• Nausea
• Vomiting
• Abdominal pain

100.4 4. Delayed Symptoms

Some children may initially appear well but later develop:

• Worsening respiratory distress
• Fever
• Radiographic infiltrates

Therefore, a period of observation (6–8 hours) is essential even in minimally symptomatic patients.

101 Differential Diagnosis

• Aspiration from non-hydrocarbon substances
  
• Pneumonia (bacterial or viral)
  
• Bronchiolitis
  
• Foreign body aspiration
  
• Toxic alcohol ingestion
  
• CNS infections (if seizures or coma occur)

Hydrocarbon ingestion is often suggested by history, smell of the substance, and circumstantial household evidence.

102 Evaluation and Investigations

Diagnosis is primarily clinical, supported by history. Investigations help assess complications rather than diagnose ingestion.

102.1 1. Chest Radiograph

• Indicated if respiratory symptoms are present.
• Findings may include:
  • Perihilar infiltrates
  • Atelectasis
  • Hyperinflation
  • Pleural effusion (rare)

Changes may lag behind clinical symptoms by a few hours.

102.2 2. Pulse Oximetry and Blood Gases

Useful in moderate to severe cases to evaluate oxygenation and acid-base status.

102.3 3. Laboratory Tests

• Full blood count (may show leukocytosis due to inflammation)
• LFTs (if hepatotoxic hydrocarbons suspected)
• Renal function tests

102.4 4. ECG

Indicated when aromatic or halogenated hydrocarbons are ingested due to risk of dysrhythmias.

102.5 5. Toxicology testing

Rarely available or required in Ghana. Management is usually based on clinical findings and history.

103 Management

The mainstay of treatment is supportive care. Specific antidotes do not exist for most hydrocarbons.

103.1 1. Initial Stabilisation

Follow ABC principles:

• Airway: Assess for coughing, choking, or obstruction.
• Breathing: Provide oxygen for hypoxia. Prepare for ventilation in severe cases.
• Circulation: Monitor perfusion and BP.

Avoid stimulation or rough handling, especially when aromatic hydrocarbons are involved, as catecholamine surges may trigger arrhythmias.

103.2 2. Decontamination

Do NOT induce vomiting.
Do NOT perform gastric lavage.

Both actions increase aspiration risk and worsen lung injury.

Activated charcoal is NOT recommended because it does not bind hydrocarbons effectively and increases aspiration risk.

103.3 3. Supportive Respiratory Care

• Administer supplemental oxygen.
• Nebulised bronchodilators for wheezing.
• Antibiotics are not routinely indicated unless the child has:
  • Fever beyond 24–48 hours
  • Leukocytosis suggestive of bacterial superinfection
    
  • Typical pneumonia features

103.4 4. Management of Complications

103.4.1 Chemical Pneumonitis

• Treat primarily with supportive care.
• Corticosteroids have no proven benefit and are not routinely recommended.
• Mechanical ventilation may be required for respiratory failure.

103.4.2 CNS Depression

• Place child in lateral position.
• Protect airway.

103.4.3 Arrhythmias

• Avoid adrenaline unless absolutely necessary.
• Treat torsades or VT according to paediatric ACLS protocols.

103.4.4 Hepatic/Renal Injury

• Supportive management.
• Avoid nephrotoxic drugs.

103.5 5. Observation

Asymptomatic children who ingested small amounts should be observed for 6–8 hours. If stable with a normal exam, they may be discharged.

103.6 6. Indications for Admission

• Persistent cough or respiratory distress
• Hypoxia
• Abnormal chest radiograph
• CNS symptoms
• Arrhythmias
• Ingestion of halogenated hydrocarbons or aromatic solvents

104 Prognosis

Most children who ingest small amounts of low-toxicity hydrocarbons such as kerosene recover fully with supportive care. Mortality is generally related to aspiration rather than systemic toxicity.

Complications may include: - Secondary bacterial pneumonia - ARDS - Respiratory failure - Rarely, hepatic or renal dysfunction (depending on substance)

Early supportive care significantly improves outcomes.

105 Prevention

Prevention is the most important strategy in reducing hydrocarbon poisoning. Practical measures relevant to Ghana include:

• Avoid storing kerosene or petrol in drink bottles or food containers.
• Keep fuel containers tightly sealed and out of reach of children.
• Educate caregivers about the dangers of inducing vomiting.
• Encourage safe storage practices in markets and shops.
• Advocate for child-proof containers and proper labelling by suppliers.
• Promote community education through CHPS compounds and local clinics.

106 Public Health and Policy Considerations

Hydrocarbon ingestion represents a wider challenge related to safety standards, household socioeconomic constraints, and health literacy. Key considerations:

• Many Ghanaian households rely on kerosene due to inconsistent electricity supply.
• Informal sale of fuel in recycled water bottles increases accessibility to toddlers.
• National campaigns on poison prevention could reduce incidence.
• Teaching community health nurses to recognise and counsel families can have lasting impact.

107 Key Points

• Hydrocarbon ingestion is common among children under five, especially in settings where fuels are used for cooking.
  
• Aspiration is the primary cause of morbidity and mortality.
  
• Do not induce vomiting or give activated charcoal.
  
• Management is mainly supportive with focus on respiratory care.
  
• Prevention through safe storage and community education is essential.

108 Further Reading

1. Shannon M, Borron SW, Burns MJ. Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose. 4th ed. Saunders; 2007.
   
2. World Health Organization. Poisoning Prevention and Management Guidelines. WHO Press.
   
3. Benson BE, et al. Hydrocarbon toxicity. Clin Pediatr Emerg Med.
   
4. Ghana College of Physicians and Surgeons (GCPS). Paediatric Toxicology Training Notes.
   
5. Jackson Y, et al. Accidental ingestion of hydrocarbons in children. Arch Dis Child.
   
6. Oluwatosin O, et al. Patterns of childhood poisoning in West Africa. Niger J Paediatr.