A toddler who swallowed a mouthful of kerosene is coughing and has tachypnoea. Gastric lavage is being considered. Why is lavage generally CONTRAINDICATED in this case?

• A Kerosene neutralises gastric acid, so lavage adds no benefit
• B Kerosene is adsorbed so completely by activated charcoal that lavage is redundant
• C Lavage risks forcing low-viscosity hydrocarbon into the airway, causing chemical pneumonitis ✓
• D Kerosene undergoes complete first-pass metabolism before systemic absorption

Explanation

Kerosene and other petroleum distillates have low viscosity and high volatility, so any passage through the pharynx during vomiting or lavage carries a high risk of aspiration into the tracheobronchial tree, where they destroy surfactant and cause chemical pneumonitis, the main cause of morbidity and death. Lavage is therefore reserved only for large recent ingestions with airway protection. Charcoal does not bind hydrocarbons effectively, and the danger is pulmonary rather than gastric.

Reference: The Essentials of Forensic Medicine and Toxicology, K.S. Narayan Reddy, 33rd ed.

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Written and medically reviewed by the StethoPrep medical team.