Chemical burn with cresol intoxication and multiple organ failure

Chemical removal of m-cresol: a critical review

m-Cresol containing wastewater has generally become a globally environmental issue due to its refractory and high toxicity towards plants, animals and human being. The development of m-cresol related industries increases the risk of excessive m-cresol discharge, making high efficiency methods to treat m-cresol an urgent topic in both economic and environmental aspects. This review focuses on the chemical treatment methods of m-cresol wastewater, including chemical adsorption, photocatalytic degradation, electrocatalytic degradation and catalytic wet oxidation. The efficiency, cost and process optimization of different methods are discussed in detail. Chemical adsorption is convenient but has relatively low efficiency. Photocatalytic degradation is an easily operated technology with high efficiency, but the selection of catalyst is too limited and the cost of light source is relatively high. Electrocatalytic degradation is time-saving but energy-intensive, and operational difficulty brings a barrier to industrialization. Catalytic wet oxidation (CWO) is highly effective and easily modified, but the performance and stability of catalysts are still very moderate. Following this, the selection and application of different methods regarding the requirement of actual environment are analyzed. Finally, a perspective on the opportunities and development for efficient m-cresol removal method is given.

Acute carbolic acid poisoning: A report of four cases

Phenol (carbolic acid) is one of the oldest antiseptic agents. Apart from being used in many commercially available products, in rural India, it is often used in the household to prevent snake infestation. We hereby present four cases of acute carbolic acid poisoning which we saw over the last monsoon. The cases highlight the multiple routes of absorption of carbolic acid as well as its multi-organ complications which often necessitate intensive care of local therapy decreases systemic phenol absorption from cutaneous exposure and may help in reducing severity.

Acute concentrated phenol dermal burns: Complications and management

Phenol burns can result in multiple organ failure. This is a case report of acute severe phenol dermal burn after accidental splash of 94% phenol on 35-year-old patient's body who was brought to hospital after 90 min of exposure. Decontamination was done with high-density water and glycerol. Early complications in form of metabolic acidosis and acute renal failure required hemodialysis. Extensive protein denaturation was managed with IV albumin and high protein diet. Patient also developed pleural effusion and acute respiratory distress syndrome, but these were successfully managed by intercostal drain tube insertion and noninvasive ventilation. The patient survived after multiple organ failures and widespread burns despite the fact that it has been observed that outcome of phenol burns with >60² inches of skin affected or two or more organs failure involving renal system is nearly fatal.

Acute tubular necrosis due to cutaneous contact with cresol

The authors report a case of a 43-year-old woman who presented with second degree chemical burns to 9% of the total body surface area due to cutaneous contact with cresol. This was associated with acute oliguric kidney injury requiring haemodialysis. In contrast to previous reports of cresol ingestion, the patient did not have evidence of hepatic dysfunction, possibly due to a low cresol concentration in the portal vein and liver. Renal histopathology showed regional accentuated tubular necrosis and disruption of the tubular basement membrane. Renal toxicity was thought to be due to direct tubular toxicity and impaired renal blood flow.

Chemical burn caused by topical vinegar application in a newborn infant

Although there is increasing interest in "alternative medicine," including nontraditional and homeopathic remedies, all around the world, they are not always safe and beneficial and may have adverse effects. We report a chemical burn caused by vinegar applied topically to lower body temperature in a febrile newborn and discuss briefly chemical skin burns caused by organic acids.

Prolonged elimination half-life of phenol after dermal exposure

BACKGROUND

Phenol is a general protoplastic poison which has been in use in medicine and industry for decades. It is readily absorbed through the skin causing both local and systemic toxicity.

CASE REPORT

A 47-year-old male had 90% phenol spilled over his left foot and shoe (3% of body surface area). After a 4 1/2-hour exposure, manifestations included confusion, vertigo, faintness, hypotension, ventricular premature beats, atrial fibrillation, dark-green urine, and tense swelling, blue-black discoloration, hypalgesia, and hypoesthesia of the affected area. Treatment consisted of irrigation with copious amounts of water, incisions, and supportive measures.

RESULTS

Peak serum phenol was 21.6 micrograms/mL, considered in the fatal range. Peak urine phenol plus urine-conjugated phenol was 13,416 mg/g creatinine, indicating a major absorption. Elimination half-life was 13.86 hours, considerably longer than previously reported.

CONCLUSIONS

Prolonged skin contact with concentrated phenol in an occlusive environment may result in a major absorption and a long elimination half-life even if the area involved is small. Prolonged elimination may be explained by extensive tissue distribution or by "slow-release reservoir" properties of the skin. Such exposure may be associated with severe systemic and local toxicities. Immediate removal from exposure and aggressive decontamination of the skin are essential to reduce these risks.

Phenol burns and intoxications

Phenol burns and intoxications are life-threatening injuries. Roughly 50 per cent of all reported cases have a fatal outcome. Only a small number of cases have been reported with high serum concentrations after phenol burns who survived. In our own experience a patient with 20.5 per cent total body surface area deep partial skin thickness phenol burns and serum concentrations of 17,400 micrograms/litre survived after immediate and repeated treatment of the scalds with polyethylene glycol (PEG) and silver sulphadiazine. A literature review of experiences with phenol intoxications reveals the advantages of PEG application. Questions on the need for enforced diuresis and haemodialysis as well as the initial treatment procedures are discussed. Advantages of different solutions for local therapy are reported.