CO-OPERATIVE KEROSENE POISONING STUDY

Abstract

A co-operative study of the ingestion of kerosene and other petroleum distillate products was carried out among 46 participating hospitals in various cities in the United States and Canada. The basic objectives of the study were the evaluation of gastric lavage as a treatment for the ingestion of petroleum products and the development and formulation of a pattern for the co-operative exchange of information pertaining to poisoning problems. Reports were obtained on a total of 760 patients; 299 of these were submitted by seven participating hospitals that alternated the use and the omission of gastric lavage on even and odd dates of the month in accordance with protocol, and it is primarily on these alternated cases that conclusions regarding the relationship between gastric lavage and the development of complications were based. The other cases were used to examine various epidemiologic characteristics of the problem. Gastric lavage was not harmful to the patients, but there was no conclusive evidence that it was beneficial. The presence of pulmonary complications and of pulmonary complications associated with fever were more closely correlated to the presence of vomiting and to the ingestion of amounts greater than one ounce of petroleum distillates than to the use or omission of gastric lavage. Patients developed complications in the absence of both vomiting and lavage, thus allowing the inference that bloodstream absorption is a factor in the toxicity of these products to humans. Although the case fatality rate is relatively small (only 2 fatalities in the 760 cases) the incidence and the morbidity is substantial. On the basis of National Health Survey figures and reports to the National Clearinghouse for Poison Control Centers it is estimated that about 28,000 such ingestions occur annually in the United States, and in the current series of 760 patients, 62% were hospitalized. Kerosene was by far the commonest type of petroleum distillate product ingested, although mineral seal oil, gasoline, lighter fluid, and a variety of others were involved. Mineral seal oil is the most dangerous from the standpoint of the frequency of toxic manifestations. Treatments reported other than gastric lavage were oxygen, oxygen under pressure, penicillin and other antibiotics, and corticosteroids. In order to determine conclusively whether or not gastric lavage is useful in the treatment of petroleum distillate ingestions it is recommended that an additional co-operative study be carried out. Such a study should include in addition to the factors recorded in this study, the following items: 1. A uniformly recommended specific technique for lavage (with perhaps one additional alternative). 2. Sharper definition of, and closer adherence to, criteria for complications including a history of the presence of cough or gagging at the time of ingestion, and the routine use of serial x-ray. 3. The use of electroencephalography to explore and delineate central nervous system complications. 4. The preservation and analysis of the various types of kerosene and petroleum distillates involved and if possible, quantitative analysis of constituents of kerosene in these samples, in the blood and perhaps in the expired air of the patients ingesting the substances.