Kerosene-induced severe acute respiratory failure in near drowning: Reports on four cases and review of the literature

Objective: The purpose of this study is to present an unusual respiratory a nd cardiovascular course after intoxication and near drowning in a river co ntaminated with kerosene. Design: Case reports and review of the literature. Setting: Intensive care unit of a university-affiliate hospital. Patients: Four patients after near drowning. Intervention: Supportive only, Results: The four patients developed acute respiratory failure. Cardiomyopa thy was present in three patients and a persistent hypokalemia in two patie nts. The onset of the symptoms was delayed, which led to underestimation of the severity of their illness. Two of the four patients died. The diagnosi s of hydrocarbon intoxication was based on bronchoalveolar lavage results, neutrophilic alveolitis with the presence of lipid-laden macrophages, and e vidence of lipoid pneumonia from the autopsy performed on one victim. One p atient who clinically deteriorated and another who developed a severe restr ictive pulmonary disorder were treated with corticosteroids, which were eff ective only in the latter patient. Conclusions: Acute kerosene intoxication in a near-drowning event often res ults in severe respiratory and cardiac failure, with a high fatality rate, Treatment with corticosteroids may lead to a rapid improvement in lung func tion.