About a cresol intoxication

Abstract

Cresols are phenol derivatives commonly used as surface disinfectants. Ingestion may cause local mucocutaneous damage and extensive systemic toxicity : central nervous, cardiovascular, hematological, hepatic, renal and pulmonary. We describe the case of a 33-year-old woman who swallowed, without suicidal intent, 50 to 70 cm3 of a 50% cresol solution. Coma occurred within 5 minutes of ingestion, she presented a bradypnea with desaturation, and the SMUR team performed on-site an orotracheal intubation. On arrival at the hospital, the patient had typical caustic lesions around her mouth. Immediate management consisted of ventilatory support, instillation of activated charcoal by nasogastric tube, empirical intravenous methylene blue and effective vascular filling. Within one hour of admission, she developed hypotension, ventricular arrhythmias, and acute renal failure. Toxic hepatitis occurred within 24 hours. The 24-hour gastroscopy showed erosive esophagitis and erythematous gastropathy and duodenopathy. No urine or blood dosage can be performed. The patient left the hospital on the fifth day and her liver function normalized after one month. The treatment of phenol poisoning consists primarily of rapid decontamination and the support of vital functions. Diagnostic assays are not available routinely and anamnesis, as well as some semiological cardinal points, is essential.