PE14.1 | Kerosene Ingestion — Summary & Reflection

KEY TAKEAWAYS

Kerosene ingestion — key take-home points:

• Kerosene is the most common childhood poisoning in India, affecting children aged 1–5 years in households where it is stored in unlabelled containers.

• The primary mechanism of harm is aspiration chemical pneumonitis — not gastrointestinal absorption. Low viscosity and low surface tension allow kerosene to penetrate deeply into the airways.

• CONTRAINDICATED: induced emesis, gastric lavage, activated charcoal. These manoeuvres increase aspiration risk with no compensating benefit.

• Diagnosis is clinical — history, characteristic smell, and respiratory symptoms. CXR changes (bilateral basal infiltrates) may lag by 4–6 hours. Continuous pulse oximetry is the most useful bedside monitoring tool.

• Management is supportive: supplemental oxygen, bronchodilators for wheeze, IV fluids if needed, and careful observation for at least 6 hours. Antibiotics only for confirmed secondary bacterial pneumonia — NOT prophylactically.

• Counselling includes never storing kerosene in food containers, keeping it out of reach of children, and the national Poison Control number (1800-116-117).

REFLECT

Reflect on your own knowledge before reading this module. Had you been at the bedside when this 2-year-old arrived, would your first instinct have been to perform gastric lavage or ask about inducing vomiting? Many healthcare workers — and most families — assume that 'getting it out of the stomach' is the correct first response to any poisoning. The case of kerosene exposes how dangerous that assumption can be when the primary mechanism of harm is aspiration rather than absorption. Consider: in your future practice, what systems or reminders could you put in place to ensure you always verify the mechanism of a toxin before deciding on decontamination? How would you counsel a family who had already induced vomiting before arriving at hospital — with empathy, without blame, but with clear guidance for the future?