Medical Management Guidelines for Phenol
(C6H6O)
CAS# 108-95-2
UN# 1671 (solid), 2312 (molten), 2821 (solution)
PDF Versionpdf icon[693 KB]
Synonyms include carbolic acid, hydroxybenzene, monohydroxybenzene, benzenol, monophenol, phenyl hydroxide, phenyl alcohol, phenic acid, phenylic acid, and phenylic alcohol.
- Persons exposed only to phenol vapor do not pose substantial
risks of secondary contamination. Persons whose clothing
or skin is contaminated with liquid phenol can secondarily
contaminate personnel by direct contact or through off-gassing
vapor.
- Phenol is a flammable, highly corrosive chemical with
a sickeningly sweet, acrid odor. Phenol's odor generally
provides adequate warning of hazardous concentrations.
- Phenol is well absorbed by all routes of exposure. Exposure
by any route can cause systemic effects.
General Information
Description
At room temperature, phenol is a translucent, colorless, crystalline mass, white powder, or thick, syrupy liquid. The crystals are hygroscopic and turn pink to red in air. When pure, phenol has a sweet, tar-like odor that is readily detected at low concentrations (0.05 ppm in air). Phenol is soluble in alcohol, glycerol, petroleum, and, to a lesser extent, water. Phenol is designated as "Poison B" by the Department of Transportation (DOT), but no special containers are required due to its modest fire hazard and low reactivity.
Routes of Exposure
Inhalation
Phenol is absorbed rapidly from the lungs.
However, because of its low volatility, inhalation hazard
is limited. The odor threshold of phenol is about 100 times
lower than the OSHA PEL; therefore, it provides adequate warning
of hazardous concentrations. Phenol vapor is heavier than
air.
Children exposed to the same levels of
phenol vapor as adults may receive larger doses because they
have greater lung surface area:body weight ratios and increased
minute volumes:weight ratios. Children may be more vulnerable
to corrosive agents than adults because of the relatively
smaller diameter of their airways. In addition, they may be
exposed to higher levels than adults in the same location
because of their short stature and the higher levels of phenol
vapor found nearer to the ground.
Skin/Eye Contact
All forms of phenol cause irritation,
and acute toxic effects of phenol most often occur by skin
contact. Even dilute solutions (1% to 2%) may cause severe
burns if contact is prolonged. Systemic toxicity can result
from skin or eye exposures. Phenol vapor and liquid penetrate
the skin with an absorption efficiency approximately equal
to the absorption efficiency by inhalation. In one case, death
occurred within 30 minutes after skin contact.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface area:body weight ratio.
Ingestion
Accidental and intentional ingestions
of phenol have been reported. As little as 50 to 500 mg has
been fatal in infants. Deaths in adults have resulted after
ingestions of 1 to 32 g.
Sources/Uses
Phenol is obtained by fractional distillation
of coal tar and by organic synthesis. By far, its largest
single use is in manufacture of phenolic resins and plastics.
Other uses include manufacture of explosives, fertilizers,
paints, rubber, textiles, adhesives, drugs, paper, soap, wood
preservatives, and photographic developers. When mixed with
slaked lime and other reagents, phenol is an effective disinfectant
for toilets, stables, cesspools, floors, and drains.
Phenol was once an important antiseptic
and is still used as a preservative in injectables. It also
is used as an antipruritic, a cauterizing agent, a topical
anesthetic, and as a chemical skin-peeler (chemexfoliant).
It can be found in low concentrations in many over-the-counter
products including preparations for treatment of localized
skin disorders (Castellani's paint, PRID salve, CamphoPhenique
lotion), in topical preparations (Sting-Eze), and in throat
sprays and lozenges (Chloraseptic, Ambesol, Cepastat, Cheracol).
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 5 ppm (skin) (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 250 ppm
AIHA ERPG-2 (emergency response planning
guideline) (maximum airborne concentration below which it
is believed that nearly all individuals could be exposed for
up to 1 hour without experiencing or developing irreversible
or other serious health effects or symptoms which could impair
an individual's ability to take protective action) = 50 ppm
Physical Properties
Description: Colorless to pink crystalline mass or white powder, syrupy liquid when mixed with water.
Warning properties: Adequate; sweet, acrid odor at > 0.05 ppm.
Molecular weight: 94.1 daltons
Boiling point (760 mm Hg): 359°F (182°C)
Freezing point: 104.9°F (43°C)
Specific gravity: 1.06 at 68°F (20°C) (water = 1)
Vapor pressure: 0.36 mm Hg at 68°F (20°C)
Gas density: 3.24 (air = 1)
Water solubility: (9% at 77°F) (25°C); hygroscopic
Flammability: 175°F (79°C)
Flammable range: 1.7% to 8.6% (concentration in air)
Incompatibilities
Phenol reacts with strong oxidizers,
calcium hypochlorite, aluminum chloride, and acids.
Health Effects
- Exposure to phenol by any route can produce systemic poisoning.
Phenol is corrosive and causes chemical burns at the contact
site.
- Symptoms of systemic poisoning often involve an initial,
transient CNS stimulation, followed rapidly by CNS depression.
Coma and seizures can occur within minutes or may be delayed
up to 18 hours after exposure.
- Other symptoms include nausea, vomiting, diarrhea, methemoglobinemia,
hemolytic anemia, profuse sweating, hypotension, arrhythmia,
pulmonary edema, and tachycardia.
Acute Exposure
As a corrosive substance, phenol denatures
proteins and generally acts as a protoplasmic poison. Phenol
may also cause peripheral nerve damage (i.e., demyelination
of axons). Systemic poisoning can occur after inhalation,
skin contact, eye contact, or ingestion. Typically, transient
CNS excitation occurs, then profound CNS depression ensues
rapidly. Damage to the nervous system is the primary cause
of death from phenol poisoning. However, damage to other organ
systems (e.g., acid-base imbalance and acute kidney failure)
may complicate the condition. Symptoms may be delayed for
up to 18 hours after exposure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
Initial signs and symptoms may include nausea, excessive sweating, headache, dizziness, and ringing in the ears. Seizures, loss of consciousness, coma, respiratory depression, and death may ensue. Coma and seizures usually occur within minutes to a few hours after exposure but may be delayed up to 18 hours.
Cardiovascular
Phenol exposure causes initial blood pressure elevation, then progressively severe low blood pressure and shock. Cardiac arrhythmia and bradycardia have also been reported following dermal exposure to phenol.
Respiratory
Mild exposure may cause upper respiratory tract irritation. With more serious exposure, swelling of the throat, inflammation of the trachea, tracheal ulceration, and an accumulation of fluid in the lungs can occur. Ingestion may lead to death from respiratory failure.
Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways.
Children may be more vulnerable because of relatively increased minute ventilation per kg and failure to evacuate an area promptly when exposed.
Metabolic
Metabolic acidosis may occur with ingestion.
Gastrointestinal
Nausea, vomiting, abdominal pain, and diarrhea are common symptoms after exposure to phenol by any route. Ingestion of phenol can also cause severe corrosive injury to the mouth, throat, esophagus, and stomach, with bleeding, perforation, scarring, or stricture formation as potential sequelae.
Renal
Renal failure has been reported in acute poisoning. Urinalysis may reveal the presence of protein (i.e., albuminuria), casts, and a greento-brown discoloration of the urine.
Hematologic
Components of the blood and blood-forming organs can be damaged by phenol.
Most hematologic changes (e.g., hemolysis, methemoglobinemia, bone marrow suppression, and anemia) can be detected by blood tests or simply by the color or appearance of the blood.
Methemoglobinemia is a concern in infants up to 1 year old. Children may be more vulnerable to loss of effectiveness of hemoglobin because of their relative anemia compared to adults.
Ocular
Contact with concentrated phenol solutions can cause severe eye damage including clouding of the eye surface, inflammation of the eye, and eyelid burns.
Dermal
When phenol is applied directly to the skin, a white covering of precipitated protein forms. This soon turns red and eventually sloughs, leaving the surface stained slightly brown. If phenol is left on the skin, it will penetrate rapidly and lead to cell death and gangrene. If more than 60 square inches of skin are affected, there is risk of imminent death. Phenol appears to have local anesthetic properties and can cause extensive damage before pain is felt.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants absorbed through the skin.
Potential Sequelae
Chronic nerve damage has been reported due to acute exposure. Chemical burns may result in chronic skin and eye effects. Phenol ingestion may lead to narrowing of the esophagus, and cardiac and renal damage.
Chronic Exposure
Repeated phenol exposure in the workplace
has caused renal damage including kidney inflammation, swelling
in the kidney tubules and cells, and degenerative changes
in glomeruli. Liver damage and pigment changes of the skin
have been noted in some workers. Chronic exposure has also
been correlated with an increased risk of coronary artery
disease and insufficient blood supply to the heart in workers.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
Phenol has not been classified for carcinogenic
effects. Phenol is, however, a known promoter of tumors.
Reproductive and Developmental Effects
Phenol is not included in Reproductive
and Developmental Toxicants, a 1991 report published by
the U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences. No reports were located of developmental
or reproductive effects of phenol in humans. In animal studies
phenol has been reported to be embryotoxic and fetotoxic,
but not teratogenic. In experimental animals, phenol has generally
not caused developmental effects except at doses that also
caused maternal toxicity.
Special consideration regarding the exposure
of pregnant women is warranted, since phenol has been shown
to be genotoxic at high doses; thus, medical counseling is
recommended for the acutely exposed pregnant woman. No known
teratogenic effects from acute exposure are known.
Prehospital Management
- Victims exposed only to phenol vapor do not pose substantial
risks of secondary contamination. Victims whose clothing
or skin is contaminated with liquid phenol can secondarily
contaminate response personnel by direct contact or through
off-gassing vapor from heavily soaked clothing. Protect
rescue personnel with butyl rubber gloves and aprons. Phenol
vapor may also off-gas from the toxic vomitus of victims
who have ingested phenol.
- Phenol is corrosive and causes severe chemical burns on
contact. Systemic effects can occur from all routes of exposure
and may include convulsions, sudden collapse, coma, nausea,
vomiting, diarrhea, methemoglobinemia, hemolytic anemia,
profuse sweating, hypotension, arrhythmia, pulmonary edema,
and tachycardia.
- There is no antidote for phenol. Rapid decontamination
may greatly affect the odds of survival. Treatment consists
of support of respiratory and cardiovascular functions.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Phenol is a severe irritant and highly
toxic systemic poison that is absorbed well by inhalation
and through the skin.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of phenol vapor.
Skin Protection: Chemical-protective
clothing (butyl rubber gloves and aprons) is recommended because
phenol liquid and vapor can be quickly absorbed through the
skin and may contribute to systemic toxicity. Contact with
liquid phenol can cause severe skin burns.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically
contaminated children, such as measures to reduce separation
anxiety if a child is separated from a parent or other adult.
Decontamination Zone
Patients exposed only to phenol vapor
who have no skin or eye irritation may be transferred immediately
to the Support Zone. Other patients will require decontamination
as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Rapid skin decontamination is critical.
Patients who are able may assist with their own decontamination.
Rescuers should wear protective clothing
and gloves while treating patients whose skin is contaminated
with phenol. Remove contaminated clothing rapidly and either
irrigate or wipe exposed areas immediately and repeatedly
with low-molecular-weight polyethylene glycol (PEG 300 or
PEG 400) which can be diluted to 50% for easier application.
Treatment should be continued until there is no detectable
odor of phenol. If PEG is not available, a glycerine solution
can be used instead. If neither of these are available, irrigation
with a high-density shower will reduce phenol uptake, but
lesser amounts of water will merely dilute the phenol and
expand the area of exposure. After treatment with the high
pressure shower, the skin should be washed with soap and water
for at least 15 minutes. Decontamination must begin as
soon as possible to minimize phenol absorption. Double-bag
contaminated clothing and personal belongings.
Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Flush exposed or irritated eyes with
copious amounts of water or saline for at least 15 minutes.
Remove contact lenses if easily removable without additional
trauma to the eye. If a corrosive material is suspected or
if pain or injury is evident, continue irrigation while transferring
the victim to the Support Zone.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g). A
soda can and straw may be of assistance when offering charcoal
to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk, egg whites,
or gelatin solution; if the patient is symptomatic, delay
decontamination until other emergency measures have been instituted.
Consider appropriate management of chemically
contaminated children at the exposure site. Provide reassurance
to the child during decontamination, especially if separation
from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete,
move victims to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination or who have been exposed
only to vapor generally pose no serious risks of secondary
contamination. In such cases Support Zone personnel require
no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g), if
it has not been given previously. A soda can and straw may
be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk, egg whites,
or gelatin solution if this has not been given previously;
or, if the patient is symptomatic, delay decontamination until
other emergency measures have been instituted.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If a chemical has been ingested, prepare
the ambulance in case the victim vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients with significant exposures,
skin burns over a large body-surface area, who have ingested
phenol, or who have experienced serious symptoms such as syncope
or convulsions should be transported to a medical facility
for evaluation. (The severity of exposure can be estimated
by the concentration of phenol and the amount and duration
of contact.)
Persons who have been exposed only to
phenol vapor and are asymptomatic are not likely to develop
complications. After their names, addresses, and telephone
numbers are recorded, these patients may be released from
the scene with instructions to seek medical care promptly
if symptoms develop (see Patient Information Sheet
below).
Emergency Department Management
- Hospital personnel can be secondarily contaminated by
direct contact or from vapor off-gassing from heavily soaked
clothing or from the vomitus of victims who have ingested
phenol. Protect hospital personnel with butyl gloves and
aprons. Patients do not pose contamination risks after contaminated
clothing is removed and the skin is thoroughly washed.
- Phenol is corrosive and causes severe chemical burns on
contact. Systemic effects can occur from all routes of exposure
and may include convulsions, sudden collapse, coma, nausea,
vomiting, diarrhea, methemoglobinemia, hemolytic anemia,
profuse sweating, hypotension, arrhythmia, pulmonary edema,
and tachycardia.
- There is no antidote for phenol. Rapid decontamination
may greatly affect the odds of survival. Treatment consists
of support of respiratory and cardiovascular functions.
Decontamination Area
Unless previously decontaminated, all patients suspected of contact with liquid phenol and all victims with skin or eye irritation require decontamination as described below. Because phenol is absorbed through the skin, don butyl rubber gloves and apron before treating patients. Phenol readily penetrates most rubbers and barrier fabrics or creams, but butyl rubber provides good skin protection. All other patients may be transferred to the Critical Care area.
Be aware that use of protective equipment by the provider may cause fear in children, resulting in decreased compliance with further management efforts.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants absorbed through the skin. Also, emergency room personnel should examine childrenĆ¢ā¬ā¢s mouths because of the frequency of hand-to-mouth activity among children.
ABC Reminders
Evaluate and support airway, breathing, and circulation. Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways. In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, surgically create an airway.
Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly).
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25ā0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive, or have seizures or ventricular arrhythmias should be treated in the conventional manner.
If evidence of shock or hypotension is observed begin fluid administration. For adults, bolus 1,000 mL/hour intravenous saline or lactated Ringer's solution if blood pressure is under 80 mm Hg; if systolic pressure is over 90 mm Hg, an infusion rate of 150 to 200 mL/hour is sufficient. For children with compromised perfusion administer a 20 mL/kg bolus of normal saline over 10 to 20 minutes, then infuse at 2 to 3 mL/kg/hour.
Basic Decontamination
Rapid skin decontamination is critical. Patients who are able may assist with their own decontamination.
Rescuers should wear protective clothing and gloves while treating patients whose skin is contaminated with phenol. Remove contaminated clothing rapidly and either irrigate or wipe exposed areas immediately and repeatedly with low-molecular-weight polyethylene glycol (PEG 300 or PEG 400) which can be diluted to 50% for easier application. Treatment should be continued until there is no detectable odor of phenol. If PEG is not available, a glycerine solution can be used instead. If neither of these are available, irrigation with a high-density shower will reduce phenol uptake, but lesser amounts of water will merely dilute the phenol and expand the area of exposure. After treatment with the high pressure shower, the skin should be washed with soap and water for at least 15 minutes. Decontamination must begin as soon as possible to minimize phenol absorption. Double-bag contaminated clothing and personal belongings.
Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.
Flush exposed or irritated eyes with copious amounts of water or saline for at least 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue irrigation while transferring the patient to the Critical Care Area.
In cases of ingestion, do not induce emesis. If the victim is alert, asymptomatic, and has a gag reflex, administer a slurry of activated charcoal at 1 gm/kg (usual adult dose 60ā90 g, child dose 25ā50 g), if it has not been previously given. A soda can and straw may be of assistance when offering charcoal to a child.
Victims who are conscious and able to swallow should be given 4 to 8 ounces of milk, egg whites, or gelatin solution if this has not been given previously; if the patient is symptomatic delay decontamination until other emergency measures have been instituted.
Critical Care Area
Be certain that appropriate decontamination has been carried out (see Decontamination Area above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Children may be
more vulnerable to corrosive agents than adults because of
the relatively smaller diameter of their airways. Establish
intravenous access in seriously ill patients if this has not
been done previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Consider the
health of the myocardium before choosing which type of bronchodilator
should be administered. Cardiac sensitizing agents may be
appropriate; however, the use of cardiac sensitizing agents
after exposure to certain chemicals may pose enhanced risk
of cardiac arrhythmias (especially in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients in respiratory distress or who
have abnormal pulmonary examinations may require chest radiography
and pulse oximetry (or ABG measurements). Beta-blockers may
be more effective than lidocaine in treating patients who
have arrhythmias.
Skin Exposure
If liquid phenol came in contact with
the skin, chemical burns may result; treat as thermal burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Eye Exposure
Continue irrigation for at least 15 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have severe corneal injuries.
Ingestion Exposure
Do not induce emesis. If the patient
is alert, administer a slurry of activated charcoal at 1 gm/kg
(usual adult dose 60-90 g, child dose 25-50 g), if not done
previously. A soda can and straw may be of assistance when
offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk, egg whites,
or gelatin solution if this has not been given previously;
if the patient is symptomatic, delay decontamination until
other emergency measures have been instituted.
Consider endoscopy to evaluate the extent
of gastrointestinal tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyroidotomy.
Gastric lavage is useful in certain circumstances to remove
caustic material and prepare for endoscopic examination. Consider
gastric lavage with a small nasogastric tube if: (1) a large
dose has been ingested; (2) the patient's condition is evaluated
within 30 minutes; (3) the patient has oral lesions or persistent
esophageal discomfort; and (4) the lavage can be administered
within 1 hour of ingestion. Care must be taken when placing
the gastric tube because blind gastric-tube placement may
further injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless performed under endoscopic guidance.
Toxic vomitus or gastric washings should
be isolated (e.g., by attaching the lavage tube to isolated
wall suction or another closed container).
Antidotes and Other Treatments
There is no antidote for phenol. Although
charcoal hemoperfusion can remove free phenol from the blood
and exchange transfusion has been suggested for phenol poisoning,
the clinical value of these procedures is unproven.
Patients should be checked for methemoglobinemia.
Symptomatic patients should be treated by slowly administering
1 to 2 mg/kg of 1% methylene blue intravenously. Further doses
may be required.
Laboratory Tests
The diagnosis of acute phenol toxicity
is primarily clinical based on CNS depression and other symptoms
such as skin burns, nausea, profuse sweating, and cardiac
arrhythmia. Routine laboratory studies for all exposed patients
include CBC, glucose, and electrolyte determinations. Depending
on the initial evaluation, additional studies for patients
exposed to phenol include ECG monitoring and kidney-function
tests. Laboratory tests to determine hemolysis include peripheral
blood smear, urinalysis, and plasma free hemoglobin and haptoglobin
analyses. Chest radiography and pulse oximetry (or ABG measurements)
are also recommended for severe inhalation exposure or if
pulmonary aspiration is suspected.
Urinary phenol levels above 81.5 mg/L
or creatinine levels above 250 mg/g suggest overexposure.
Disposition and Follow-up
Consider hospitalizing patients who have
evidence of systemic toxicity from any route of exposure.
Delayed Effects
Because pulmonary edema or CNS effects
may be delayed, patients who have suspected serious exposure
should be observed and reexamined periodically for 18 to 24
hours.
Patient Release
Patients who have mild exposure and remain
asymptomatic for 2 to 4 hours may be discharged with instructions
to seek medical care promptly if symptoms develop (see the
Phenol-Patient Information Sheet below).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Patients who have skin or eye burns
should be reexamined in 24 hours. Patients with significant
phenol intoxication may be at risk and should be monitored
for long-term CNS (peripheral neuropathy) gastrointestinal,
and cardiac and renal damage.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
phenol.
Print this handout only.pdf icon[44.5 KB]
What is phenol?
Phenol may be found as a translucent,
clear, or light-pink crystalline mass; a white powder, or
a clear liquid. It has a sweet, sharp odor. Phenol is used
in many commercially available products including plastics,
resins, fertilizers, paints, photographic developers, and
some medicines.
What immediate health effects can result from phenol exposure?
Poisoning can occur when phenol gets
on the skin or in the eyes, when it is inhaled, or when it
is swallowed. Skin and eyes can be mildly or severely burned,
depending on how much and how long the phenol was in contact
with them. Breathing phenol vapors can burn the lining of
the nose, throat, and lungs, just as it burns the skin. Severe
injury to the lungs can cause them to fill with fluid, making
breathing difficult. Swallowing phenol burns the lining of
the digestive tract and can result in internal bleeding. Generally,
the more serious the exposure, the more severe the symptoms.
Phenol is absorbed easily into the body through the skin,
lungs, and stomach. The brain is very sensitive to phenol.
Phenol can cause seizures and coma and may interfere with
the brain's control of regular breathing patterns. It can
cause dangerous rhythm changes in the heart.
Can phenol poisoning be treated?
There is no antidote for phenol, but
its effects can be treated, and most exposed persons do get
well. Persons who have had a serious exposure may need to
be hospitalized. If phenol got in your eyes, the doctor may
put a special dye in your eyes and examine them with a magnifying
device. If you swallowed phenol, you may have been given a
solution containing charcoal, which will soak up phenol in
your stomach.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a severe exposure, you may not notice
any symptoms for up to 24 hours.
What tests can be done if a person has been exposed to phenol?
Depending on the severity of symptoms, the doctor may order blood tests, urine tests, chest x-ray, and a heart monitoring test. These tests may show whether damage has been done to the heart, kidneys, lungs, or nervous system, Abnormally high amounts of phenol may be found in the urine if exposure was severe. Testing is not needed in every case.
Where can more information about phenol be found?
More information about phenol can be
obtained from your regional poison control center; your state,
county, or local health department; the Agency for Toxic Substances
and Disease Registry (ATSDR); your doctor; or a clinic in
your area that specializes in occupational and environmental
health. If the exposure happened at work, you may wish to
discuss it with your employer, the Occupational Safety and
Health Administration (OSHA), or the National Institute for
Occupational Safety and Health (NIOSH). Ask the person who
gave you this form for help in locating these telephone numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print
instructions only.pdf icon[44.5 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing or wheezing
- difficulty breathing, shortness of breath or chest pain
- irregular heartbeats, pounding or fluttering in your chest
- increased pain, swelling, redness, or a pus-like discharge
where skin is burned
- unexplained drowsiness, dizziness, headache, or fainting
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.