LAMP OIL INTOXICATION, FATAL – USA (NEW JERSEY)

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A ProMED-mail post
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International Society for Infectious Diseases
<http://www.isid.org>

Date: June 2008
Source: New Jersey Poison Information and Education System [edited]
<http://www.njpies.org/documents/Press%20Releases/Torch%20Lamp%20Oil%20Mistaken%20for%20Apple%20Juice%20(June08).pdf>

Torch Lamp Oil Mistaken for Apple Juice
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6 New Jersey residents became ill recently after ingesting a small
amount of torch oil which was mistaken for apple juice. [Torch lamp
oil is used in small containers with wicks in the split tops of bamboo
poles planted around the garden or yard, to give torchlight for
outdoor festivities on summer evenings.
– Mod.JW]

One individual, an elderly woman, died 2 days after mistaking the lamp
oil for apple juice. Earlier in the month an 8-year-old girl was
hospitalized in critical condition and was placed on a ventilator also
after mistaking the torch oil for apple juice. The child survived her
illness but will live the rest of her life with damaged lungs.

In 4 of the 6 cases of lamp oil ingestion reported to New Jersey’s
Poison Information and Education System occurred when the victim drank
the oil, which looks like apple juice, thinking it was apple juice.
[The other 2 cases presumably resulted from absorption through the
skin. I suppose there is a warning on the label about the hazards of
handling the oil. – Mod.JW]

According to Bruce Ruck, PharmD. of NJPIES, “It is very important to
recognize that lamp oil bottles closely resemble juice containers.
When accidentally taken by mouth, such lamp oils can enter the lungs
causing pneumonia and death. Jugs containing lamp oils must be stored
in a locked cabinet away from storage of food and drinks.”

There are other poisonous products which look like and come in
containers closely resembling juices. It is important for families to
lock up all such potentially dangerous products, keep them far from
food and educate the entire family on the dangers of these
“look-alikes.” The NJPIES website contains a poster representation of
other dangerous look-alikes, it is found at:
<http://WWW.NJPIES.ORG>

If you suspect a poisoning, call the poison control center for
immediate treatment advice as well as for prevention information.
Call 1-800-222-1222, trained medical professionals will provide you
with the most up to date emergency treatment advice, and will answer
any drug or poison information question you may have.

Remember, Help Is Just A Phone Call Away!


Communicated by:
ProMED-mail
<promed@promedmail.org>

[It is unfortunate that the container and the color of the oil so
closely resemble that of apple juice. It is also unfortunate that a
non-food item was so closely stored with food items.

Most of these oils contain paraffins and petroleum distillates. Even
the smallest amounts of the paraffin oils when ingested find their
way into the lungs and set up severe chemical reactions resulting
usually in severely damaged lungs. Low viscosity, low surface tension
and low volatility are features of lamp oils contributing to chemical
pneumonia. Often these paraffins are methylated, which may contribute
to the lung damage. Paraffins and petroleum distillates often promote
inhalation and thus pulmonary pneumonia.

The hydrocarbons can be derived from either petroleum or wood.
Petroleum distillates include kerosene, gasoline, and naphtha, while
wood-derived hydrocarbons include turpentine and pine oil. The length
of the [chemical] chains as well as the degree of branching determine
the phase of the hydrocarbon at room temperature; most are liquid, but
some short-chain hydrocarbons (e.g., butane) are gas at room
temperature, while other long-chain hydrocarbons (e.g., waxes) are
solid at room temperature.

Toxicity from hydrocarbon ingestion can affect many different organs,
but the lungs are the most commonly affected. The chemical properties
of the individual hydrocarbon determine the specific toxicity, while
the dose and route of ingestion affect which organs are exposed to the
toxicity.

The toxicity of hydrocarbons is directly related to their physical
properties, specifically the viscosity, volatility, surface tension,
and chemical activity of the side chains.

Viscosity is a measure of resistance to flow and is measured in
Saybolt Seconds Universal (SSU). Substances with a lower viscosity
(SSU less than 60, e.g., turpentine, gasoline, naphtha) are associated
with a higher chance of aspiration. The surface tension is a cohesive
force created by van der Waals forces between molecules and is a
measure of a liquid’s ability to “creep.” Like the viscosity, the
surface tension is also inversely related to aspiration risk; the
lower the viscosity, the higher the risk of aspiration.

Volatility is the tendency for a liquid to change phases and become a
gas. Hydrocarbons with a high volatility can vaporize and displace
oxygen, which can lead to a transient state of hypoxia [oxygen lack].
Not surprisingly, the degree of volatility is directly related to the
risk of aspiration. The amount of hydrocarbon ingested has not
consistently been linked to the degree of aspiration, and hence
pulmonary toxicity.

Toxicity from hydrocarbon exposure can be thought of as different
syndromes, depending on which organ system is predominately involved.
Organ systems that can be affected by hydrocarbons include the
pulmonary, neurologic, cardiac, gastrointestinal, hepatic, renal,
dermatologic, and hematologic systems.

Pulmonary complications, especially aspiration, are the most
frequently reported adverse effect of hydrocarbon exposure. While the
aliphatic hydrocarbons have little GI absorption, aspiration
frequently occurs, either initially, or in a semidelayed fashion as
the patient coughs or vomits, thereby resulting in pulmonary effects.
Once aspirated, the hydrocarbons can create a severe pneumonitis.

Hydrocarbon pneumonitis results from a direct toxic affect by the
hydrocarbon on the lung parenchyma. The type II pneumocytes are most
affected, and as such, surfactant production and function are
altered. The end result of hydrocarbon aspiration is interstitial
inflammation, intra-alveolar hemorrhage and edema, hyperemia,
bronchial necrosis, and vascular necrosis.

Once ingestion has occurred, the induction of vomiting can exacerbate
the condition and result in more of the paraffin and petroleum
distillates reaching the lungs. This is a medical emergency and the
container as well as the patient should be transported to an
emergency room. The container hopefully retains the label identifying
the various contents and providing the physician with a method of
recommended treatment.

Portions of this commentary have been extracted from:
<http://www.emedicine.com/EMERG/topic873.htm>
– Mod.TG

Link: Toxic oil syndrome (TOS) appeared as a new disease in Spain in 1981
<http://www.ehponline.org/press/toxoil.html>
– Mod.JW]

[see also:
Chemical contamination, sunflower oil – Spain ex Ukraine: RFI  20080428.1458
2004
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Toxic ingestion, tung oil – China (Hunan) 20040503.1218]
………………..tg/ejp/jw
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