Young children are frequently poisoned by agents that are attractive and readily available to them. The combination of curiosity, desire to mimic parental behavior (such as drinking from a bottle or can), newly acquired developmental milestones, and access to household products, makes children younger than 6 years particularly vulnerable to hazardous household chemicals. Thus, these substances represent the third most common poisoning exposure in young children.1
Most concerning household chemicals fall into three main categories: hydrocarbons, alcohols, and caustics. Table 167-1 lists some common products and their potentially toxic components. Among children for whom medical attention is sought for poisoning from such agents, ingestion is by far the most common route of exposure.
TABLE 167-1Contents of Common Household Products ||Download (.pdf) TABLE 167-1 Contents of Common Household Products
|Product ||Contents ||Category |
|Toilet bowl, porcelain cleaners ||Sulfuric, hydrochloric acid ||Caustic/corrosive, acid |
|Drain/pipe openers ||Sodium, potassium hydroxide ||Caustic/corrosive, alkali |
|Lighter fluid (naphtha), gasoline, kerosene, butane ||Petroleum distillates ||Hydrocarbons |
|Pine oil, lamp oil, potpourri oil ||Terpenes (plant extracts) ||Hydrocarbons |
|Mouthwash ||Ethanol ||Alcohols |
|Sterno fuel, windshield wiper fluid ||Methanol ||Alcohols |
|Antifreeze ||Ethylene glycol ||Alcohols |
|Rubbing alcohol ||Isopropyl alcohol ||Alcohols |
|Airplane glue, inhalants ||Toluene, xylene ||Aromatic/halogenated hydrocarbons |
|Hair relaxer crème ||Sodium hydroxide ||Caustic/corrosive, alkali |
|“No-lye” hair relaxer crème ||Calcium hydroxide ||Caustic/corrosive, alkali |
|Mothballs ||Camphor ||Aromatic hydrocarbons |
Hydrocarbon compounds include petroleum distillates (lighter fluid, kerosene, mineral oil, naphtha, gasoline, butane); plant extract oils, also referred to as terpenes (turpentine, lamp oil, menthol, eucalyptus oil); camphor; inhalants (toluene, chlorofluorocarbons); and organic solvents (toluene, xylene, benzene).
After ingestion, hydrocarbon compounds enter the esophagus but also spread into the tracheobronchial tree, and the lungs are the primary target of injury. The potential for a given substance to cause direct lung injury is influenced by its (1) viscosity, (2) surface tension, and (3) volatility. Low-viscosity liquids with high volatility and low surface tension have the highest potential for pulmonary injury. Highly viscous hydrocarbons (motor oil, paraffin) very seldom cause lung injury, whereas low-viscosity substances (gasoline, kerosene) easily enter the lungs. The chemical can cause alveolar collapse and damage surfactant, which can lead to pneumonitis and in some cases can progress to respiratory failure.
In addition, lipid-soluble hydrocarbons, such as terpenes and aromatics can easily cross the blood-brain barrier and cause central nervous system (CNS) depression. Other organ damage may result from a particular compound’s inherent toxicity. Table 167-2 offers a mnemonic, which lists the hydrocarbons and their specific systemic toxicity. Inhalant abuse of organic solvents is associated with a sudden death syndrome via sensitization of the myocardium to catecholamines and can also cause a chronic encephalopathy. Because petroleum distillates and terpenes account for the majority of pediatric hydrocarbon exposures, the remainder of this discussion will focus on pulmonary toxicity.