The toddler in the garage: severe hydrocarbon toxicity from accidental ingestion

Abstract

Background: This case report highlights the risk of severe liquid hydrocarbon poisoning in children. Hydrocarbons may cause neurological, cardiac and respiratory toxicity with limited literature to guide potential toxic doses, expected trajectory or management guidelines.Case report: A 15-month-old boy was found by his mother collapsed in the garage. She reported last seeing him 10 min prior while finishing dinner. She heard him gagging in the garage and immediately attended, finding him unresponsive and foaming at the mouth. This was followed by profuse vomiting and during the phone call to Queensland Ambulance Service, he stopped breathing and progressed to cardiac arrest with asystole. Next to him, was an open bottle of BostiK AW 802 ABS cleaner, the major ingredient of which are hydrocarbons, which may cause seizures, chemical pneumonitis, cardiotoxicity and hepatotoxicity. Toxic ingestion of an unknown quantity was suspected. There was no evidence of trauma. He had prolonged cardiopulmonary resuscitation for 37 min prior to return of spontaneous circulation. His airway was soiled with vomit with extensive sloughing present on laryngoscopy. An orogastric tube was inserted and gastric contents aspirated. Oxygenation and ventilation remained challenging throughout, and he was maintained on high dose adrenaline, noradrenaline, and vasopressin for refractory shock. On transfer to hospital, he developed widespread bleeding. Investigations showed severe metabolic acidosis with highest pH 6.9 and lactate 19 and multiorgan failure with severe pulmonary oedema and signs of chemical pneumonitis, diffuse intravascular coagulation, liver and renal failure despite extensive resuscitation. Emergent retrieval was organised via helicopter to Queensland Childrens Hospital Pediatric Intensive Care Unit for ongoing support. Unfortunately, he continued to deteriorate despite resuscitative efforts and increasing supports. He passed away in his parents' arms nine hours following the suspected ingestion.Conclusions: Accidental ingestion of cleaners may rapidly lead to fatal toxicity in children. Hydrocarbons with low viscosity, such as this cleaner, are associated with higher toxic potential.