Acute dermal and inhalational exposure

A 49 year old male arrived in hospital after being found unconscious at work about 18 hours after a hose containing toluene had ruptured. He had superficial burns over the shoulder and arm (about 10% of the body surface area) and was thought to have aspirated toluene. He had dyspnoea and was dehydrated with mild hypothermia. Black urine was noted on catheterisation. A chest X-ray showed a shadow on the lower left side. Laboratory analyses revealed acidosis, raised creatinine and hyperkalaemia; the urine was positive for myoglobin and he was oliguric. Toluene was present in blood and urine. He was rehydrated with sodium bicarbonate and intravenous fluids which reduced the hyperkalaemia within 12 hours. Administration of mannitol increased the urine output but by the next day furosemide (frusemide) was required. However, the urea continued to rise and he was haemodialysed. The burns were treated supportively. Liver function tests were elevated on day five. By 10 days after admission the lung shadow had resolved and he had moderate polyuria. He recovered completely (Reisin et al., 1975).

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