Severe cresol poisoning caused by massive dermal exposure

Excerpt

A 34-year-old man with a history of epilepsy was found after falling into a washing tank, containing 60% cresol and 40% xylene in a plastic factory. He was brought to a local hospital, where he presented as unconscious, in shock, and experiencing respiratory failure. Four hours post-exposure, he was given emergent endotracheal intubation and then transferred to a tertiary medical center. Upon arrival, he had altered mental status (Glasgow Coma Scale: E3VtM4). A physical examination revealed a brownish-black dermal discoloration over his torso, extremities, genital area, and buttocks, with a clear margin dividing the unaffected skin (Fig. 1, Panel A). The skin lesion was edematous and soft without bullae or eschar formation. Furthermore, the color of the urine in his urine drainage bag was dark red (Fig. 1, Panel B). Laboratory findings reported hemolysis, metabolic and respiratory acidosis, and acute renal failure. An ECG recording showed sinus tachycardia with multiple ventricular premature contractions. Diagnosed with 67% total body surface area (TBSA) of cresol chemical burning with systemic toxicity, he received decontamination treatment with large amounts of water and polyethylene glycol. He was then admitted to the intensive care unit with fluids and sodium bicarbonate supplement. After intensive care with venous-to-venous extracorporeal membrane oxygenation and continuous renal replacement therapy, he was discharged on the 45th day with a favorable outcome. The patient still had multiple skin scars.

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