Chemical pneumonitis after intravenous injection of isoparaffin: Characteristic clinico-radiologic findings.

A 23-year-old man presented with chest pain after intravenous (IV) injection of isoparaffin (C12-C13, 99%). This report describes the chest computed tomography (CT) pattern of chemical pneumonitis after IV isoparaffin injection. When injected IV, hydrocarbon can cause chemical pneumonitis, mimicking pulmonary infarction on chest CT. The CT pattern is attributable to diffusion of hydrocarbons through systemic veins into small pulmonary arteries and capillary beds, causing extensive local reactions and chemical pneumonitis or pleuritis.

Unique drowning in an atypical medium: paraffin wax in the setting of a motor vehicle crash--case report and literature survey.

Among the various modes of death due to asphyxiation, drowning is unique. Unlike other types of suffocation associated with occluding airway obstructions (i.e. choking and smothering); with drowning, there is typically filling and involvement of the majority of the tracheobronchial tree and aerodigstive tract. Although the usual drowning medium is water, it can also occur in other media. Moreover, although drowning sometimes occurs in the setting of a motor vehicle accident, an element of vehicular submersion or immersion is usually operative in such instances. The case presented here is that of a motor vehicle crash which resulted in drowning where no immersion of the vehicle occurred. Moreover, the drowning medium was paraffin wax, rather than water. Other cases in the literature of drowning in atypical media and also those which are reported in the concomitant presence of a motor vehicle accident are presented.

The epidemiology of childhood poisonings in Cyprus.

Information on childhood poisonings in Cyprus is limited. Our objective was to examine the epidemiology of poisonings among children in Cyprus. All children up to 15 years of age admitted for poisoning to the Archbishop Makarios Hospital in Nicosia, Cyprus between 2005 and 2008 were included in our study. All hospital poisoning records were reviewed. A total of 257 children were admitted for poisoning. The mean age of children was 3.1 years, of which 83.7% were below the age of 5 years old, while 53% were boys. The poisoning hospitalizations accounted for about 3% of all admissions to the pediatric department during the study period (4 years). The annual cumulative incidence of childhood poisoning hospitalizations was 116 per 100,000 children. Medications accounted for 46.1% of all poisonings, the most frequent cause being paracetamol (9.8%), cardiovascular medications (5.3%), antitussive medications (4.5%), and other painkillers (4.1%). Another 37.6% of hospitalizations involved household products such as household cleaning products (11.8%), petroleum products (11.0%), and rodenticides (5.7%). Among children who ingested petroleum distillates, 55.6% developed clinical symptomatology. The vast majority of cases were accidental (93.8%). Suicidal cases involved children 8-14 years old, mainly girls, and the most frequent poisoning ingested was paracetamol (46.7%). Poisoning hospitalizations represent an important cause of morbidity among children in Cyprus. Preventive strategies should include the education of caregivers on the handling of medications and household products as well as legislation requiring child-resistant packaging for all medications and household products including petroleum distillates.

Paraffin (kerosene)* poisoning in under-five children: a problem of developing countries.

Although developed countries have largely eliminated the problem of paraffin ingestion in young children, many developing countries have not. Paraffin, used as a home energy source, particularly in rural area, accounts for a significant percent of paediatric poisoning and can lead to serious health problems, complications and death. This paper presents a review done by a nurse clinician concerned about the number of paediatric poisonings she saw in the hospital in one developing country, Botswana. The first stage of solving the problem is presented in which she established the extent and epidemiology of the issue. Suggestions for its solution are also discussed. It is hoped that this can serve both to increase awareness in developing countries of the dangers of paraffin poisoning and serve as a model for nurse clinicians and researchers in developing countries.

Accidental paraffin poisoning in Kenyan children.

A serious and common accident in rural Kenyan homesteads is accidental ingestion of paraffin when it has been mistaken for water and offered to a young child. Here we report the incidence, parental practices and outcome of severe paraffin poisoning, requiring admission at Kilifi District Hospital, Kenya. Over a 2-year period, 48 children (0.5% of all admissions) were admitted with kerosene poisoning, constituting 62% of all poisoning cases. All cases were accidental. Ten per cent had induced vomiting. One child (2%) died. We suggest these data support assessment followed by implementation of practical and affordable measures to prevent paraffin poisoning.

Isoparaffin poisoning in an 18-month-old girl.

We report on an 18 month girl who presented having ingested and aspirated a mouthful of Isoparaffin stored in a bottle of mineral water served to her unwittingly by her grandmother. The patient subsequently developed respiratory distress and multiple bilateral lung abscesses.

Multiple organ failure following lamp oil aspiration.

CASE REPORT: A 26-month-old previously healthy boy of 15 kg was admitted to our hospital due to cyanosis following the aspiration of lamp oil. Aspiration resulted from the patient's father inducing emesis by digital stimulation of the boy's throat after the patient had ingested an unknown amount of lamp oil. Endotracheal intubation was done on the second hospital day in the Pediatric Intensive Care Unit (PICU) due to respiratory failure manifested by hypercapnia and hypoxemia. Mechanical ventilation, including high frequency oscillatory ventilation (HFOV) with iNO at 20 ppm, was started. However, he developed a spiked fever and developed an acute respiratory distress syndrome, a pneumothorax, and diffuse subcutaneous emphysema. His course was further complicated by anuric renal failure, rhabdomyolysis, severe hepatitis, pancytopenia, elevation of cardiac enzymes, and disseminated intravascular coagulation over the following days. He died on the ninth day of hospitalization because of multiorgan failure.

Risk assessment of short-chain chlorinated paraffins in Japan based on the first market basket study and species sensitivity distributions.

The chemical risks of short-chain chlorinated paraffins (SCCPs) to human health and ecological species in Japan were assessed in this study. SCCPs are used as extreme pressure additives in metal-working fluids and flame retardant agents in plastic materials. The first market basket study with a high resolution gas chromatography and mass spectrometry with electron capture negative ionization is reported. Total daily food intakes for Japanese residents of different ages were estimated using Latin Hypercube simulations, and the highest 95th percentile intake is 6.8 x 10(2) ng/kg/day for a 1-year-old child. Based on the reported no-observed-adverse-effect-level (NOAEL) and the estimated exposure mainly from food, it was concluded thatSCCPs are not posing risks to humans in Japan. Ecological risks to aquatic and sediment organisms were estimated using species sensitivity distributions. The 95th percentiles of the distributions obtained by fitting several environmental SCCP concentration data of river water and sediment were 41.8 ng/L and 558 ng/g wet weight as the possible highest concentrations, respectively. No-observed-effect-concentrations (NOEC) were determined by calculating the fifth percentiles of a species sensitivity distribution, which were 2.2 microg/L for aquatic organisms and 1.7 to 13.5 mg/ kg wet weight for sediment organisms. While it is likely that there is no imminent environmental chemical risk for aquatic organisms at a regional level in Japan, this study concluded that a more detailed risk assessment is necessary for sediment organisms.

Acute renal toxicity after ingestion of Lava light liquid.

A 65-year-old man with a history of alcohol abuse and seizure disorder presented to the emergency department with altered mental status, increased anion gap acidosis, phenytoin toxicity, and acute kidney failure. The patient had ingested the liquid contents of a Lava light, which contained chlorinated paraffin, polyethylene glycol (molecular weight 200), kerosene, and micro-crystalline wax. Gas chromatography-mass spectrophotometry of the patient's blood produced results consistent with the same analysis of the Lava light contents. After 3 days of declining mental status and worsening kidney function, the patient required hemodialysis. After a prolonged hospitalization, the patient was discharged home with residual renal insufficiency. Although multifactorial, the associated renal toxicity was most probably related to the low molecular weight polyethylene glycol content of the lamp's liquid contents.

Aspects of poisoning with traditional medicines in southern Africa.

During 1981-1985, 1306 patients were admitted to Ga-Rankuwa Hospital due to acute poisoning. The major causes were paraffin (59.0%) and traditional medicines (15.8%). The mortality from paraffin was low (2.1%), but poisoning from traditional medicine resulted in a high mortality (15.2%) and accounted for 51.7% of all deaths. The traditional healer was the main source (83.4%), of traditional medicines, while 11.6% was bought from African medicine shops. The rest was acquired from other sources. In 82.5% of cases traditional medicines were taken orally, and in 10.5% of cases they were administered as an enema. Poisoning by traditional medicines was always accidental and probably due to overdosage. Vomiting, diarrhea, and abdominal pain were the most frequently encountered symptoms while the lungs, liver, and central nervous system were commonly affected. Treatment consisted of ventilation, intravenous fluids, and other palliative measures. A great deal of secrecy still surrounds traditional medicine, hampering rational therapy. Questioning of patients and interviews with traditional healers facilitated the identification of a number of major etiological agents. This elucidated the problem and should promote effective treatment.

Pneumatoceles as a complication of paraffin pneumonia.

Paraffin pneumonia is a common form of poisoning, but pneumatoceles are an uncommon complication. This is a report of 6 patients who developed pneumatoceles after the ingestion of paraffin. These children's ages varied from under 18 months to 4 years; they were clinically more ill and were hospitalised longer than those who did not develop pneumatoceles. The pneumatoceles were discovered at the earliest on day 6 and, although extensive and in 2 cases bilateral, caused no clinical impairment of respiratory function. The pneumatoceles appear to resolve spontaneously but this may take more than 200 days.

Computerized tomography in pneumatocoeles after paraffin ingestion.

Paraffin pneumonia is a common form of poisoning but pneumatocoeles are an uncommon complication. This is a report of the computerized tomography (CT) of seven patients who developed pneumatocoeles after the ingestion of paraffin. The finding on the CT are presented and the situation and characteristics of the pneumatocoeles are indicated.