Acute exposure

Inhalation

The victim should be removed from exposure and all contaminated clothing removed. The respiratory function should be assessed. Further treatment is symptomatic and supportive. See below for management of systemic effects.

Dermal

Contaminated clothing should be removed and the skin thoroughly irrigated with water or saline. Further treatment is symptomatic and supportive. See below for management of systemic effects.

The eyes should be thoroughly irrigated with water or saline for 15 minutes and then stained with fluorescein. Referral to an ophthalmologist is recommended if there is any uptake of fluorescein.

Ingestion

Gastric lavage may be considered if ingestion was recent, however, because of the risk of aspiration a cuffed endotracheal tube must be used to protect the airway. Activated charcoal is unlikely to be of benefit. If there has been any vomiting, coughing or wheezing then the patient will need to be assessed to determine if aspiration has occurred. Treatment is supportive. See below for management of systemic effects.

Toxicology of Solvents Systemic effects

It is essential to check electrolytes, blood gases, renal and hepatic function, urinalysis and creatine phosphokinase (CPK) particularly in patients with generalised weakness. Monitor ECG in symptomatic patients.

Renal tubular acidosis is treated conventionally with correction of hypokalaemia then acidosis. It is essential to correct the hypokalaemia before giving sodium bicarbonate as bicarbonate worsens hypokalaemia and hypocalcaemia. This can result in arrhythmias and rhabdomyolysis. No attempt should be made to correct acidosis until the potassium concentration is above 3 mmol/l (Kroeger et al., 1980). Potassium chloride should not be used since patients usually have hyperchloraemic acidosis. Regular monitoring of electrolytes, blood gases and ECG is essential. Hypocalcaemia (resulting in tetany) may occur during fluid and electrolyte repletion and should be managed with calcium supplementation if necessary.

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