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An Unusual Accidental Kerosene Poisoning. Case Report

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Abstract

Kerosene aspiration is toxic and harmful to children. Cases of chemical pneumonitis from kerosene poisoning had been reported in older children. It is however more worrisome to see such cases in infants. Here is a case study of a two month old infantwho was accidentally given kerosene in place of water. The child was diagnosed of chemical pneumonitis from kerosene ingestion and aspiration. The patient responded well to medication, recovered fully and discharged home after her care-giver was counselled on kerosene (poison) and drug prevention. We advised that hospital efforts should further be complimented by strengthening and supporting institutions saddled withdrug, food and poison control prevention like National Agency for Food, Drug Administration and Control (NAFDAC) in Nigeria.
ARC Journal of Pediatrics
Volume 2, Issue 1, 2016, PP 1-3
www.arcjournals.org
©ARC Page | 1
An Unusual Accidental Kerosene Poisoning. Case Report
*Baba Usman Ahmadu (MBBS, MHPM, FMCPaed),
Apollos Nachanuya Chafi (MBBS), Harry ClaphtonDifirwiti (MBBS),
Adzu Yusuf (MBBS), 1Ambe Jose Pwavimbo (MBBS,FMCPaed)
Department of Paediatrics, Federal Medical Centre, Yola, Adamawa state, Nigeria.
1 Department of Paediatrics, University of Maiduguri Teaching Hospital, Borno state, Nigeria
*ahmadu4u2003@yahoo.com
Abstract: Kerosene aspiration is toxic and harmful to children. Cases of chemical pneumonitis from kerosene
poisoning had been reported in older children. It is however more worrisome to see such cases in infants. Here
is a case study of a two month old infantwho was accidentally given kerosene in place of water. The child was
diagnosed of chemical pneumonitis from kerosene ingestion and aspiration. The patient responded well to
medication, recovered fully and discharged home after her care-giver was counselled on kerosene (poison) and
drug prevention. We advised that hospital efforts should further be complimented by strengthening and
supporting institutions saddled withdrug, food and poison control prevention like National Agency for Food,
Drug Administration and Control (NAFDAC) in Nigeria.
Keywords: Kerosene chemical pneumonitis, Kerosene poisoning, infant, Accidentprevention and control,
FMC-Yola, Nigeria.
1. INTRODUCTION
Kerosene is a hydrocarbonmixture of paraffin and naphthalene, which is widely used for cooking
meals, heating andlightning of home in developing countries like Nigeria (1-3).Gas, electricity and
other forms of energy are used for similar purposes in developed countries abroad. Developing
countries are backwards in terms of alternative source of energy,as such people from those regions of
the world mostly rely on kerosene, which is more accessible (3). Generally, five percent of childhood
poisoning and a quarter of under-fivedeathare from accidental hydrocarbon ingestion, kerosene being
foremost (2). Kerosene poisoning mostly affectrespiratory, centralnervous and gastro-intestinal
systems, rarely are other organs involved(1).Chemical pneumonitis and bronchitis are the most
common features of kerosene poisoning (1-3).
Kerosene isusually kept in water containers or in polythene bagsparticularly in our communities;this
has ledto its accidental ingestionby children who often thought is water. Rarely is kerosene poisoning
heard off in infants below three months of age and vast literature search on this issue showed dearth
of information (1-5). Reason could be due to non-attainment of relevant motor milestones required by
subjects to explore their surroundings. Herein, we report a case of aspiration pneumonitis secondary
to kerosene ingestion in a two month old infantwho has been on predominant breastfeeding and cared
for by both parents and maternal grandmother. The aims of thecase study were to describe the
clinicalpresentationand optimal management of kerosene poisoning. To enlightened care-givers on
kerosene (poison) and drug control preventive measures both at the hospital and at agency level like
NAFDAC.
2. CASE SUMMARY
MIB, a two months old infant was admitted into Federal Medical Centre (FMC), Yola on account of
accidental kerosene ingestion. Child was doing well until when grandmother inadvertently took
kerosene which was in a water container and poured it into the feeding bottle and gave the child.
Child started having cough and vomiting after ingesting the product. She later developed difficulty in
breathing, examination revealed a well fed childweighing 4.9 kg with a temperature of 38.1 0 C. she
was in respiratory distress, respiratory rate of 80 breaths per minute not cyanosed, flaring of alai nasai
with bilateral fine crepitation. The heart rate was 130beats per minute, heart sounds were S1 and S2, no
murmurs. Abdominal and central nervous systems were essentially normal. Diagnosis of aspiration
pneumonitis was made clinically and patient was placed on intranasal oxygenand intravenous fluids.
Baba Usman Ahmadu et al.
ARC Journal of Pediatrics Page | 2
She had parental antibiotic and was on nil per oral. There was improvement after 48 hours;
temperature came down to 37.30 C,respiratory distress subsided, chestbecame clear clinically.
Intravenous fluid was discontinued and patient commenced on oral feeding. Intravenouscefuroxime
was then changed to the oral form. She was discharged on the 5th day of admission after care giver
was counselled on preventive measures that included exclusive breastfeeding and safe storage of
kerosene. Chest radiograph and Electrocardiograph were notobtained due to financial constrain. Her
packed cell volume was 36%, White Blood Cell Count was 6.1 x 109, neutrophil was 66%, eosinophil
was 4% and lymphocyte was 30%.The blood picture showed reversal of neutrophil- lymphocyte ratio
suggestive of bacterial infection for her age bracket. However, blood culture was negative. Follow-up
a week after discharge revealed a stable child.
3. DISCUSSIONS
In developed states, the use of alternative source of energy in homes had substantially replaced
kerosene. This is not so in developing countries where kerosene is still extensively used. Therefore,
cases of accidental kerosene poisoning in children could be found much more in developing than in
advanced societies (1-5).Kerosene is a liquid mixture of chemicals produced from distillation of crude
oil, if a child accidentally aspirates it, that child stand the risk of having chemicalpneumonia as was
the case here.Like most chemicals, the amount of kerosene associated with adverse health effects must
be above a certainlevel. Unfortunately, threshold toxicity value for kerosene is still not very clear
partly because only small quantity less than 30mls areingested at any given time (2, 3). On the
contrary,some investigators had published children who survived ingestion of up to 1.7 g kg-1 of
kerosene. They further stated that doses ranging from approximately 2 to 17 g kg-1 are associated with
about 30% fatality (4-7).Lung exposure tokerosene vapor may cause non-specific signs such as cough,
vomiting, difficulty in breathing, fever, dizziness, headache etc.
Cough, vomiting, difficulty in breathing and fever were found on the index case at presentation. The
observation corroborated that of Ashir et al (1) in Maiduguri, Nagi and Abduallah (2) in Iraq. The
respiratory symptoms and signs produced by aspiration pneumonia could be attributed to some
properties of kerosene being its volatility, vapor pressure and surface tension (2, 3). That is why it is
pertinent not to induce vomiting in a child who had ingested kerosene. Vomiting after kerosene
ingestion increases a child’s vulnerability to aspiration which in turn leads to chemical
pneumonia.Several researchers had reported poor systemic absorption of kerosene from the gastro-
intestinal tract, therefore, respiratory or even nervous systems manifestations are due to hypoxia and
acidosis from injured lungs and not due to systemic absorption (1-6). Risherand Rhodes (4) in their
study of toxicological profiles for fuel oils in the United States experienced more than half of children
presenting with kerosene ingestion are asymptomatic. Moreover, those with chemical pneumonitis
will in most cases respond to treatment like the present case. Mortality is low because kerosene has
low volatility which allows air concentrations at approximately 100mg/m3known as NOAEL (no
observable adverse effect level) (2-4, 7). Nonetheless, however, high grade fevercan heighten
kerosene toxicity by inducing narcotic effects like narcolepsy, cataplexyand death (8, 9).Other
symptoms like dizziness and headache could not be picked in our patient due to her very young age.
Care givers of current case could not complete the child’s investigation. Chest radiograph and
electrocardiograph could not be obtained because of lean financial resource on the path of the care
givers.Similar finding was made by Authors from Al-Khansa Children's Hospital in the city of Mosul
(2). Majority of patients diagnosed of kerosene poisoning are from poorfamilies, living in crowded
conditions wherekerosene use is extensive coupled withsuboptimal care andsupervision of children (2,
3).
Standard best practice entails removalof patient from site of kerosene exposure, oxygen delivery,
maintaining a clear airway withadequate ventilation and applying other measures as indicated by the
patient’s clinical condition (1-3).This platform was followed in the course of managing our patient.
Worthy of note is that gastric lavage or inducedvomiting should be avoided. Consider gastric
aspiration within one hour of kerosene ingestion or if very large amounts was taken or there is
concern about another toxin, provided the airway can be protected (1-3).Patients who ingested little
quantity of kerosene and are not showing symptoms of aspiration pneumonia,such patients can be
observed at home under supervision for about six hours, with an advice to go to hospital immediately
if features emerge (3).
An Unusual Accidental Kerosene Poisoning. Case Report
ARC Journal of Pediatrics Page | 3
The toxic and harmful effects of kerosene entails thatcare must go beyond secondary prevention by
educating care-givers on proper kerosene storageusing locked containers,kept in a safe place. Induced
vomiting or gastric emptying and the use of feeding bottle at home should be discouraged while
promoting exclusive breastfeeding, good hygiene and sanitation and immunization. These primary
preventive measures were discussed with the child’s care-givers in the form of counselling and
education at the hospital. Other relevant body like NAFDAC must carry the preventive crusade in-line
with Drug, Food and Poison control policy to care-givers at home, wards or communities directly or
by using media outfits etc. Very rarely does a case of kerosene poisoning require tertiary or quartnary
prevention.
4. CONCLUSIONS
Kerosene poisoning is associated with majority of childhood chemical pneumonia. Primary preventive
measures that need to be considered to avoid accidental exposure of aninfant to it are first, storing
kerosene in locked containers placed in a safe environment. Secondly,the practice and promotion of
exclusive breastfeeding in children from birth up to six months be encouraged, thereafter,
complimentary feeds be gradually instituted. Thirdly, immunization, proper hygiene, environmental
sanitation and avoidance of bottle feeding must be practiced. Where the accident had occurred, patient
should be taken to the hospital for quality care by way of secondary prevention. In some remote cases
the continuum of care could involve tertiary and or quaternary preventions. Induced vomiting at home
should be avoided.
ACKNOWLEDGEMENT
We thank Ja’afaru UN and Adamu H for their technical assistance.
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... Vomiting occurred due to the irritating effect of kerosene on the gastric mucosa. Vomiting, whether spontaneous or induced, increases the risk of aspiration and the severity of pneumonia (Ahmadu et al., 2016). Drowsiness was observed mainly in ICU admitted patients due to hypoxia as it is usually associated with pulmonary manifestations. ...
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Background: kerosene is a common cause of childhood poisoning specially in low and middle-income countries. Complications are primarily related to pulmonary aspiration which is a significant contributor to Intensive Care Unit (ICU) admission. Objectives: To study the clinical profile of kerosene poisoning in children presented to Menoufia Poison Control Centre and to identify patients who need ICU admission. Methods: a prospective study including children presented to Menoufia Poison Control Center with acute kerosene poisoning during the period of three years from 2018 to 2020. Results: During the study period, a total number of 154 children were admitted. Male children were 56.5% and females represent 43.5%. More than half of cases (52.6%) were less than 3 years. The majority of cases were from rural areas (76.6%). All cases were exposed to kerosene orally and 24.9% had combined oral and dermal exposure. ICU admitted cases had longer period of hospitalization and presented mainly by tachypnea, hypoxemia and chest retractions. Conclusion: Respiratory system is mainly affected in kerosene poisoning. Patients presenting with respiratory distress, moderate or severe grades of PSS, hypoxemia on presentation should be admitted to the ICU. Community education is necessary to reduce this preventable poisoning in children.
... Vomiting occurred due to the irritating effect of kerosene on the gastric mucosa. Vomiting, whether spontaneous or induced, increases the risk of aspiration and the severity of pneumonia (Ahmadu et al., 2016). Drowsiness was observed mainly in ICU admitted patients due to hypoxia as it is usually associated with pulmonary manifestations. ...
... Vomiting occurred due to the irritating effect of kerosene on the gastric mucosa. Vomiting, whether spontaneous or induced, increases the risk of aspiration and the severity of pneumonia (Ahmadu et al., 2016). Drowsiness was observed mainly in ICU admitted patients due to hypoxia as it is usually associated with pulmonary manifestations. ...
... For prevention of chemical pneumonitis, steroids (initially at dose of 0.5 mg/kg and gradually tapered off) along with broad-spectrum antibiotic therapy are recommended. [8] These medications are also helpful in patients who have a preexisting respiratory illness or who develop complications. Bronchoalveolar lavage is reserved for kerosene-induced lipoid pneumonia as it can remove lipid-laden macrophages. ...
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Tension Pneumothorax following an Accidental Kerosene Poisoning: A Case Report
  • G Ashir
  • A Rabasa
  • M Gofama
  • S Yahaya
G.M Ashir, A.I Rabasa, M.M Gofama, S.M Yahaya. Tension Pneumothorax following an Accidental Kerosene Poisoning: A Case Report. Niger Med J2009; 50(4):95-6.
Kerosene (Fuel Oil).Health Protection Agency Compendium of Chemical Hazards
  • Rp Chilcott
RP Chilcott. Kerosene (Fuel Oil).Health Protection Agency Compendium of Chemical Hazards. 2006, Version 1. www.hpa.org.uk.
Toxicological profiles for fuel oils. USDepartment of Health and Human Services
  • J F Risher
  • S W Rhodes
Risher J. F, Rhodes S. W. Toxicological profiles for fuel oils. USDepartment of Health and Human Services 1995.