Treatment and Management
CE Original Date: August 1, 1993
CE Expiration Date: February 28, 2007
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|The following is about treatment and management.|
No antidote exists for toluene intoxication; care is supportive. In cases of acute exposure, treatment consists of removal of patients from the contaminated environment, support of cardiopulmonary function, and prevention of further absorption.
Patients with inhalation exposure might require low-flow oxygen (approximately 40%) and hydration. More severe cases might require assisted ventilation. Contaminated clothing should be removed and isolated, decontaminated, or disposed of safely. Exposed skin should be washed thoroughly with soap and water. Treatment of ocular exposure should begin with irrigation for at least 15 minutes.
In cases of toluene ingestion, induction of emesis is contraindicated because of the risk of CNS depression and subsequent pulmonary aspiration from vomiting. Standard regimes for administering a cathartic and activated charcoal should be followed. If the patient has ingested a large amount (>5 milliliters [mL] or greater than 1 teaspoon) of toluene and is examined within 30 minutes of ingestion, the benefits of gastric lavage should be weighed against the risk of pulmonary aspiration. Ingestion of a small amount (<5 mL or less than 1 teaspoon) of toluene can be treated by administering activated charcoal orally without emptying the gut. Activated charcoal should be used cautiously because in some cases it can cause vomiting, which may be hazardous to a patient who has ingested a volatile hydrocarbon or has a diminished level of consciousness. Children have important toxicokinetic and physiologic differences that make their responses to environmental exposures different from those of adults. The behaviors and activities of children can introduce greater opportunities for exposure to contaminants in air, water, and soil, compared with those of adults living in the same environment. Children differ from adults in their exposures and can differ in their susceptibility to hazardous chemicals: the same amount might have a significantly different effect.
Epinephrine and other catecholamines should also be used cautiously, because of risk of cardiac dysrhythmias. In substantial intoxications, fluid and electrolytes should be monitored. Metabolic acidosis is usually accompanied by severe hypokalemia; therefore, administration of bicarbonate should be avoided because bicarbonate can worsen hypokalemia by causing intracellular shifting of potassium. Hypocalcemia can occur after electrolyte replenishment; it should be corrected with intravenous calcium. Use appropriate supportive treatment to correct acute renal failure if it occurs.
Discharge planning should include follow up of hepatic, renal, and neuropsychologic status and referral for substance-abuse treatment when appropriate. In the clinical case presented, a developmental pediatric evaluation should take place to closely monitor the offspring for toluene embryopathy syndrome.
Environmental conditions that might have led to unintentional exposures should be corrected.
No specific clinical treatment exists for patients who have been chronically exposed to toluene. Sources of exposure must be identified and minimized. Intentional volatile-solvent abusers should be referred to appropriate treatment programs.
How will you treat the patient in the case study?
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