1218

Abstract

Case Reports: Hydrocarbon pneumonitis has not been well described in the literature. There are only a few cases with the ingestion of hydrocarbons and the inhalation of hydrochlorofluorocarbons (HCFCs) causing pneumonitis. The known toxic effects of inhaling hydrocarbons are central nervous system excitation or depression, arrhythmias, bone marrow depression, renal damage, liver damage and chromosome changes. We report a rare case of Acute Respiratory Distress Syndrome (ARDS) secondary to hydrocarbon inhalation.A 46 year old male with a past medical history of COPD, OSA, and bilateral nephrectomies for renal cell cancer on hemodialysis presented to the Emergency Department with acute dyspnea. The patient was working on installing a fuel pump on a truck in his enclosed garage for two hours, when he had headache, dizziness, emesis, with shortness of breath and chest pain. Due to worsening hypoxemia the patient was admitted to the Intensive Care Unit (ICU). In the ICU, the patient had hemoptysis with increasing oxygen demands, and was then intubated. Chest radiography showed bilateral infiltrates. Working diagnosis was acute hydrocarbon inhalation causing ARDS. Patient’s clinical condition significantly improved with supportive care, was extubated in 24 hours and transferred to a general medical floor on room air that evening. He was discharged from the hospital on the following day.Hydrocarbon pneumonitis is often nonspecific presenting with tachypnea, hypoxemia, hemoptysis, chest pain and infiltrates on imaging. This occurs as a result of aspiration or inhalation of volatile hydrocarbon compounds. Acute management includes supportive care with oxygen, bronchodilators, and if necessary corticosteroids. Most reported cases of acute ingestion of hydrocarbons have responded well to conservative measures. Our case with inhalation pneumonitis required ventilator support and had a rapid reversal of the lung injury.