What is Phenol Toxicity?
Phenol is a type of disinfectant and chemical that has a range of uses. Joseph Lister introduced the use of phenol, also known as carbolic acid, in antiseptic surgery, meaning surgery where every effort is made to prevent infection. However, people soon started reporting toxicity or harmful effects. While phenol was used as a healthcare disinfectant for most of the 20th century, it’s less common in today’s healthcare environment.
Despite the decrease in its use in healthcare, Phenol has been used in dermatology as a chemical peel to rejuvenate the skin. However, in recent times, laser treatments have become the preferred option. Phenol is also used by podiatrists, or foot doctors, during the treatment of ingrown toenails following their removal.
Outside the medical field, Phenol is sometimes an ingredient in household disinfectants. It’s also found in various throat gargles and ointments. Some people even use Phenol-containing solutions as a home remedy for head lice. There’s a derivative of phenol named cresols, which are also found in certain home disinfectant products and can cause similar harmful effects as phenol.
Phenol is also used in many laboratories for extracting nucleic acid, an important component of DNA, from biological samples. It’s used as a starting chemical for making many medicines and other chemicals. These include commonly used drugs like acetaminophen, aspirin, and levodopa, an anesthesia drug called propofol, and certain weed-killers.
What Causes Phenol Toxicity?
Phenol poisoning typically happens by accident at home or work, though deliberate exposure is less likely. Extreme cases of poisoning have occurred because of accidental swallowing of the substance in healthcare facilities. Persistent exposure to phenol at work, especially in industries that produce explosives or in healthcare environments, used to lead to a condition known as “phenol marasmus.” This condition caused chronic fatigue, discomfort, and liver inflammation. Nowadays, most phenol exposures happen when the substance is accidentally spilled in lab or industrial settings, leading to skin contact.
Risk Factors and Frequency for Phenol Toxicity
The National Poison Data System gets around 1,000 calls each year about phenol exposure. Most of these calls are accidents. Most people who are exposed to phenol don’t experience significant health issues. However, around 6 to 8% of cases do show serious health effects.
Signs and Symptoms of Phenol Toxicity
When attending to someone who may have been poisoned by phenol, it’s important to remember that addressing life-threatening symptoms must always be the priority. In severe poisoning cases, the patient may be too ill to provide a detailed account of the exposure. Nevertheless, as soon as possible, medical professionals should gather information on the exposure, such as the concentration and amount of phenol, how and when the exposure occurred, and whether protective gear was used.
The tell-tale sign of phenol exposure is a sweet, medicinal odor. Symptoms can appear within minutes or up to an hour after exposure, and their severity depends on how the person was exposed. They can include altered mental state or seizures, vomiting, white patches in the mouth or throat, difficulty breathing due to acute respiratory distress syndrome, and cardiovascular problems like abnormal heart rhythms and low blood pressure. A rare symptom known as “rabbit syndrome” may also appear, which involves the mouth moving rhythmically.
Phenol can also affect the skin. Contact with small amounts can cause a painless, white discoloration at the exposure site. If not promptly cleaned, the area may develop deeper burns which can progress to redness, blistering, and skin death. Initial symptoms may include redness at the contact site, followed by brown skin staining. Despite the damage, these skin areas may be painless due to phenol’s cooling, anesthetic effect. The affected skin might peel over a period of 3 to 5 days before healing starts. Repeated skin exposure to Phenol can lead to unusual skin color changes such as hyperpigmentation or hypopigmentation, also known as chemically-induced vitiligo.
Testing for Phenol Toxicity
If a person is exposed to phenol, a harmful chemical, immediate medical care is needed. However, general medical facilities might not have the resources to confirm exposure via blood or urine tests. These tests might not even alter the initial treatment provided. That being said, certain workplaces with potential benzene exposure, a chemical related to phenol, do conduct routine urine phenol tests but they play no definitive role in identifying acute phenol poisoning.
If a person is thought to have been exposed to phenol, the doctors will closely watch their vital signs such as heartbeat, breathing rate, blood pressure, and temperature. Doctors will also examine the patient’s conscious level, meaning the level of their awareness, wakefulness, and ability to understand what is happening around them.
Doctors also may need to take an electrocardiogram, a test which records the electrical signals in your heart. This is done to monitor the rhythm and functioning of the patient’s heart. Blood tests would be done not to necessarily find phenol, but to see if the kidneys aren’t working properly, if there is an imbalance of electrolytes (substances like sodium, calcium and potassium) which can lead to a condition known as metabolic acidosis, any liver damage, muscle breakdown known as rhabdomyolysis, or methemoglobinemia which is a blood disorder where too much of a particular form of hemoglobin, responsible for carrying oxygen in the body, is produced.
If the person is having trouble breathing, or if it’s thought they breathed in phenol, then a chest X-ray might be done as well. Urine might turn a blue-green color due to phenol metabolites, which are chemical products produced by the body when it’s trying to break down phenol. This blue-green urine could be a helpful clue for doctors if it’s not sure whether the person was exposed to phenol.
Treatment Options for Phenol Toxicity
If someone swallows or gets skin contact with a high concentration of phenol (more than 5%), it’s important to go to an emergency department promptly for evaluation. To find help with possible poisoning incidents within the US, call 1-800-222-1222 to reach a regional poison control center.
When treating a patient who’s been exposed to phenol, the first step is to take care of primary needs, such as ensuring the patient can breathe, is receiving enough oxygen, and their heartbeat and blood pressure are stable.
For external, or skin, exposure to phenol, there are various ways to remove the substance. Right now, the best method is to use a low molecular weight (300-400MW) polyethylene glycol (PEG) fluid. It’s important to understand that this is different from the high molecular weight PEG usually used in medical settings, such as preparing the bowels for a procedure. Low molecular weight PEG should be kept in first aid kits in any locations where phenol may be used so that decontamination can occur as soon as possible. To remove phenol on the skin, you should use a sponge or towel soaked in low molecular weight PEG. If this isn’t available, you can also rinse the affected area with plenty of water for 15 minutes. Using small amounts of water may actually cause the phenol to become more absorbed into the body. Another possible decontamination fluid for skin exposure to phenol is isopropyl alcohol. If phenol gets into the eyes, flush them with lots of water or a saline solution for at least 15 minutes after exposure.
If phenol is swallowed, it’s usually not helpful to use activated charcoal, a substance often used to treat certain types of poisonings. The risk of choking, especially if seizures occur due to the phenol, may be greater than any potential benefits of the charcoal. Additionally, activated charcoal could interfere with medical examinations looking at the digestive tract. In fact, a procedure called an upper endoscopy might be needed to look at the esophagus to determine the degree of any injury caused by ingesting phenol.
If there’s extensive skin burns from phenol exposure, the treatment should occur with a regional burn center. Although it might seem logical to try and remove the phenol from the body through a process similar to dialysis, this approach is generally not recommended. However, dialysis may still be necessary to manage complications that arise from the poisoning. Patients who experience widespread symptoms of phenol poisoning should stay under medical supervision for at least 24 hours. Patients who do not exhibit symptoms and have normal vital signs and lab results might be released from emergency care after 6 to 8 hours of monitoring.
What else can Phenol Toxicity be?
The symptoms caused by phenol poisoning can be quite varied, as this toxic substance can affect almost every organ system in the body. Hence, it’s often tricky to identify and can be mistaken for symptoms of other serious health conditions. Here are some key signs and similarities:
- With direct skin contact, phenol can cause damage similar to what other strong acids or alkaline substances do, but the skin may turn a unique brown color signifying phenol exposure. Sometimes, skin might also become discolored or lose color, which can also be a sign of hydrofluoric acid skin exposure.
- Falling into seizures and heart failure are both severe, albeit common, symptoms seen in many dangerous cases of poisoning and not exclusive to phenol.
- Interestingly, phenol can turn the urine a distinctive blue-green color. Note that propofol, a type of drug derived from phenol, might cause the same unique urine color when used as medication.
Recognizing these signs can be crucial in diagnosing phenol poisoning, and ensure the right treatment is provided.
What to expect with Phenol Toxicity
People suffering from phenol toxicity generally recover, if they are quickly decontaminated and given supportive care. However, complications could be severe. If multiple organs fail then those patients will need intensive care until they recover. “Phenol toxicity” refers to poisoning from exposure to phenols, which are chemicals used in many industries. “Decontamination” means removing or neutralizing the poison, while “supportive care” refers to treatment aimed at managing symptoms and maintaining body functions.
Possible Complications When Diagnosed with Phenol Toxicity
Skin contact with phenol, a harmful chemical, can cause damage ranging from chemical burns to dead skin and flesh. If not managed promptly, phenol poisoning can lead to many health problems. It can dull your senses and intellectual functions or cause fits, which can hinder your breathing and even lead to breathing cessation.
In severe cases, a respiratory condition called acute respiratory distress syndrome (ARDS) can develop, which may need artificial ventilation to breathe. Phenol can also trigger irregular heart rhythms and lead to total heart failure.
In certain situations, phenol can damage the kidneys to such an extent that dialysis or treatment to filter out waste from the blood is required. This damage is often due to excessive muscle breakdown or hemoglobin presence in the urine due to red blood cell destruction inside blood vessels. It’s vital to note that phenol can also harm the liver and increase the level of an abnormal form of hemoglobin, called methemoglobin, in the blood.
Common Side Effects of Phenol Poisoning:
- Chemical burns or dead skin or flesh
- Dulled senses and intellectual functions
- Fits
- Acute respiratory distress syndrome (ARDS)
- Ventricular arrhythmias (irregular heart rhythms)
- Cardiovascular collapse (heart failure)
- Acute kidney injury requiring dialysis
- Acute liver toxicity
- Methemoglobinemia (increased levels of methemoglobin in the blood)
Preventing Phenol Toxicity
If you have been exposed to phenol – a toxic chemical that’s often found in certain household and industrial products – it’s important to be aware of where it might be present so you can avoid further exposure. By checking places like your house and workplace for these sources, you can keep yourself safe and prevent any future harm from phenol.
