Abstract
Hydrocarbons from gasoline are toxins that can affect a multitude of organ systems based on the route of chemical intoxication exposure, with a majority involving oral ingestion or inhalation. Data is still incomplete concerning the systemic complications of gasoline ingestion due in part to variability in the chemical composition of various gasoline products.A 64-year-old female presented to her local emergency department following the ingestion of gasoline in a suicide attempt with altered mental status, hypotension, shortness of breath, tachypnea, sinus tachycardia, coarse rhonchi bilaterally, and hyperactive bowel sounds. Treatment upon admission included intravenous ampicillin/sulbactam, intubation, an intravenous fluid bolus, and ketamine to address the developing hypotension. The patient developed multiorgan failure and acute toxic encephalopathy despite medical interventions and hemodialysis. After four days, comfort care measures were initiated, and the patient passed away.Gasoline toxicity can have a profound effect on multiple organs based on the chemical properties and the route of exposure. These sequelae can be monitored through patient symptoms as well as radiologic imaging. Early supportive therapy and decontamination are vital in decreasing the morbidity and mortality associated with gasoline ingestion.
Highlights
Given the psychiatric effects of COVID-19, physicians must be able to recognize and treat many types of suicide attempts
Acute hydrocarbon exposure with gasoline can present as a wide array of pathology including pneumonitis, dermatitis, arrhythmia, encephalopathy, and acidosis
Intentional ingestion exposures with aspiration are associated with the least favorable outcomes
Summary
Given the psychiatric effects of COVID-19, physicians must be able to recognize and treat many types of suicide attempts. Gasoline has a relatively low surface tension, low viscosity, and high volatility which allow rapid transition between the gaseous and liquid forms This in turn can cause inhalational injury that occurs simultaneously with ingestion. She was non-adherent to her psychiatric medication regimen and claimed that she attempted suicide multiple times in the past through cutting herself as well as benzodiazepine overdose. On the second day of admission, the patient developed worsening respiratory distress that required intubation and hyperventilation to accelerate elimination of volatile hydrocarbons. Despite the appropriate supportive measures, the patient developed ongoing hypotension that failed to respond to intravenous fluids and pressors This contributed to her worsening renal function and eventual oliguric acute renal failure.
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