ASSOCIATE PROFESSOR J.L.N. MEDICAL COLLEGE AJMER

Keywords

Kerosene poisoning Pleural effusion Hydrocarbons

INTRODUCTION

Kerosene poisoning intentionally or accidentally is toxic. Lethal dose is 30 to 100 ml. The most common pulmonary manifestation is aspiration pneumonia. Rarely it may lead to complications like pneumothorax pneumatocele bonchiectasis bronchopleural fistula and bilateral haemorrhagic pleural effusion. We report herein a case of unilateral right sided pleural effusion following kerosene ingestion.

CASE REPORT

A 45 year old male presented in casualty department with complaints of progressively increasing breathlessness associated with chest pain following accidental ingestion of kerosene around 30ml about half an hour before admission. On examination he was conscious oriented but tachypnic with respiratory rate 30 min and oxygen saturation 87 . Other vital parameters were stable with pulse 88 minute regular and blood pressure 110 76mmHg. Chest auscultation revealed diminished breath sounds in right infrascapular zone. Rest of the systemic examination revealed no abnormality.

Laboratory investigation showed normal haemoglobin with raised total leucocyte count 12 200 cells cu. mm . An arterial blood gas analysis revealed arterial oxygen tension pO2 80 mmHg pCO 240 mmHg HCO3 23 mEq l and pH 7.3. Chest ray film showed right sided pleural effusion Figure 1 . Pleurocentesis was done under ultrasonic guidance. Pleural effusion analysis showed transudative picture and yielded no organisms growth. The patient was treated with oxygen supplementation corticosteroids prednisolone 1 mg kg body weight . The patient responded to the treatment and was discharged symptomatically better after 7 days of treatment.

DISCUSSION

Kerosene oil a petroleum product is a mixture of hydrocarbons contaminated with organic sulphur petrol gasoline vaseline and paraffin related hydrocarbons. 1 The most frequent adverse effect of any hydrocarbon poisoning is aspiration. Hydrocarbons with lower viscosity and higher volatility are associated with a greater chance of aspiration with resultant pulmonary injury. The type II pneumocytes are the most affected resulting in decreased surfactant production which leads to alveolar collapse ventilation perfusion mismatch and hypoxemia. The end result of hydrocarbon aspiration is interstitial inflammation intraalveolar hemorrhage and edema hyperaemia bronchial necrosis and vascular necrosis 2

The hemorrhagic alveolitis and bronchial and vascular necrosis can result in a hemorrhagic pleural effusion which has been rarely reported 3 4 So treating physicians should be aware of this rare complication. Symptoms and radiological findings resolve rapidly after cessation of exposure and corticosteroid therapy as we did in our patient.

REFERENCES

1. Bronstein AC Spyker DA Cantilena LR Jr Green J Rumack BH Heard SE. Annual Report of the American Association of Poison Control Centers National Poison Data System NPDS Clin Toxicol. 2007 45 815 917.
2. Dice WH Ward G Kelley J Kilpatrick WR. Pulmonary toxicity following gastrointestinal ingestion of kerosene. Ann Emerg Med. 1982 11 138 42
3. Prasad R Karmakar S Sodhi R Karmakar S. Bilateral hemorrhagic pleural effusion due to kerosene aspiration. Lung India. 2011 28 130 2
4. Rajashekhar P Adinagesh Vamshivhari Sivunisrilatha .A rare case of Kerosene Poisoning with right sided pleural effusion. Indian Journal Of Applied Research. 2015 5 678 79.