Prolonged elimination half-life of phenol after dermal exposure

Background: Phenol is a general protoplastic poison which has been in use i n medicine and industry for decades. It is readily absorbed through the ski n causing both local and systemic toxicity. Case Report: A 47-year-old male had 90% phenol spilled over his left foot and shoe (3% of body surface are a). After a 41/2-hour exposure, manifestations included confusion,vertigo, faintness, hypotension, ventricular premature beats, atrial fibrillation, d ark-green urine, and tense swelling, blue-black discoloration, hypalgesia, and hypoesthesia of the affected area. Treatment consisted of irrigation wi th copious amounts of water, incisions, and supportive measures. Results: P eak serum phenol was 21.6 mu g/mL, considered in the fatal range. Peak urin e phenol plus urine-conjugated phenol was 13,416 mg/g creatinine, indicatin g a major absorption. Elimination half-life was 13.86 hours, considerably l onger than previously reported. Conclusions: Prolonged skin contact with co ncentrated phenol in an occlusive environment may result in a major absorpt ion and a long elimination half-life even if the area involved is small. Pr olonged elimination may be explained by extensive tissue distribution or by "slow-release reservoir" properties of the skin. Such exposure may be asso ciated with severe systemic and local toxicities. Immediate removal from ex posure and aggressive decontamination of the skin are essential to reduce t hese risks.