Problems for Discussion - 4 - Volatile Oils

• Understand the mechanism of toxicity of individual volatile oils.
• Understand the circumstances of volatile oil poisoning.
• Detail the clinical manifestations of poisoning by the various volatile oils.
• Outline the management of volatile oil poisoning.

A two-year-old male is brought to hospital by his parents after being found 30 minutes previously with an opened 100 mL bottle of eucalyptus oil. The bottle is empty and some is spilt on his clothes. His parents say that his breath smells of eucalyptus and he is more subdued than normal. His heart rate is 110, BP 100/60 and respiratory rate 30/min.

1. Is decontamination indicated?
2. What specific management is required?
3. How would you monitor this child and for how long?
4. What is the expected prognosis?

A two-month-old male infant was brought to hospital when he failed to wake up that morning. The previous day he had a fever and nasal congestion. At presentation at the emergency department, he was dusky, was in respiratory distress, and had poor perfusion. Initial laboratory studies revealed:

• Glucose 2.3 mmol/L
• pHa 7.22
• PaCO2 26 mm Hg
• HCO2- 11 mmol/L
• Potassium 6.2 mmol/L
• Anion gap 19
• ALP 307 U/L
• AST 3225 U/L
• ALT 2856 U/L
• Ammonia 204 micromole/L
• INR 4.8

The infant's mother said that the only medication she had given him was 120 mL of tea brewed from the leaves of a home-grown mint plant the day prior.

1. What exposure(s) could have caused this presentation?
2. Outline the mechanism of toxicity.
3. Detail the management required.