Acute exposure

Inhalation

The patient 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

Emesis is not recommended because of the risk of aspiration. Activated charcoal may cause vomiting which may be hazardous to patients who have ingested hydrocarbons.

Injection

The management of patients with injection injury from white spirit depends on the route of injection. Immediate pain, local oedema and redness would be expected in all cases.

Subcutaneous injection

In cases of subcutaneous injection of hydrocarbons, early and aggressive management has been shown to reduce morbidity and prevent long-term sequelae. Cellulitis, sterile abscess formation and/or necrosis may develop, requiring excision, drainage and debridement. Analgesics and antibiotics should be given if indicated, and anti-tetanus status should be checked. Compartment syndrome has been reported following subcutaneous injection of white spirit, where fasciotomy and plastic surgery were necessary.

Intravenous injection

Conventional supportive management is recommended for patients with respiratory effects and/or pneumonitis following intravenous hydrocarbon injection.

Systemic effects

Treatment is primarily symptomatic, with support of the cardiovascular and respiratory systems. Use of epinephrine (adrenaline) or related sympathomimetic stimulants is contraindicated due to the risk of inducing ventricular fibrillation.

The level of consciousness, ECG and respiratory rate should be monitored, along with liver and kidney function in severe cases. A chest X-ray is indicated in patients with respiratory symptoms and in cases of suspected aspiration.

The efficacy of enhanced elimination techniques (e.g., haemodialysis, haemoperfusion, etc.) has not been established, but on theoretical grounds they are unlikely to be effective.

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