Clinical Practice Guidelines : Essential Oil Poisoning (original) (raw)

See also:

Poisoning – acute guidelines for initial management
Resuscitation
Hydrocarbons Poisoning
Eucalyptus oil Poisoning
Camphor Poisoning
Salicylates Poisoning

Key points

1. Mucous membrane irritation and gastrointestinal symptoms usually develop first, followed by CNS depression which increases the risk of aspiration pneumonitis
2. Aspiration pneumonitis is a risk from both the essential oil and from hydrocarbons or emulsifiers that are added to many preparations
3. Symptoms are specific to the type of essential oil. Contact poisons information for advice if specific ingestant is known

For 24 hour advice, contact the Poisons Information Centre 13 11 26

Background

• Essential oils are a common household product used for medicinal, aromatic, cleaning and other purposes
• Common essential oils include lavender, tea tree, nutmeg, sage, peppermint, wintergreen (see Salicylates Poisoning), fennel, geranium, lemon myrtle, thuja, woodworm, eucalyptus oil (see Eucalyptus oil Poisoning) and clove
• Toxicity depends on the dose and the essential oil ingested
• Toxicity can occur from the essential oil itself along with the hydrocarbons (see Hydrocarbon Poisoning) or emulsifiers added to many of the preparations

Pharmacokinetics
Essential oils mimic other fat soluble drugs. They are well absorbed through mucous membranes and the skin and are excreted unchanged or as hepatic metabolites via lungs, urine, faeces and skin. Following ingestion, onset of symptoms (including rapid onset of CNS symptoms) is usually within one hour. Signs of aspiration usually appear immediately, but can be delayed up to 6 hours. Biochemical abnormalities following large ingestions may take 10 hours to occur

Dose related toxicity

• Essential oil concentrations range from 1-20%.
• Volumes of 5-15 mL are likely to cause toxicity in adults
• Smaller Ingestions of 2-3 mL of some essential oils have been associated with toxicity in children
• Signs of toxicity include mucous membrane irritation and gastrointestinal symptoms with possible CNS depression

Children requiring assessment

• All patients with deliberate self-poisoning or significant accidental ingestion
• Any symptomatic patient
• Ingested dose >5 mL
• Any patient whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered

Risk assessment

History

Intentional overdose or accidental
Dose:

• Stated or likely dose taken
• Exact name of oil and amount/volume taken
• Preparation type and % concentration, co-ingestants, eg paracetamol

Examination

CNS: CNS depression (any change in mental state is significant), vertigo, dizziness, ataxia, seizures
CVS: Bradycardia, hypotension
Respiratory: Aspiration pneumonitis (gagging, choking, persistent coughing)
GIT: Nausea, vomiting, diarrhoea. Hepatotoxicity is associated with clove oil and pennyroyal oil ingestion
Other: Mucous membrane irritation and numbness, dermal irritation, chemical conjunctivitis and corneal scarring have been reported

Always check for Medicalert bracelet in any unconscious patient, or any other signs of underlying medical condition (fingerprick marks etc)

Investigations

Asymptomatic children with small ingestions do not usually require investigation

In all children, consider:

• Chest X-ray and blood gas if signs of aspiration pneumonitis
• UEC and LFT in patient with significant illness, large ingestions or with clove oil/pennyroyal ingestions
• Paracetamol level in all intentional overdoses

Acute Management

1. Resuscitation

• Standard procedures and supportive care
• Aspiration/chemical pneumonitis is managed supportively with oxygen and bronchodilators and may require non-invasive ventilation or intubation if severe
• Fever is common following aspiration with pneumonitis. Antibiotics should be withheld until there is objective evidence of bacterial infection. Corticosteroids and prophylactic antibiotics are not indicated

2. Decontamination
Charcoal is contraindicated due to risk of aspiration and due to the fact essential oils are rapidly absorbed.

• Specific treatments: Consider NAC for significant clove oil, pennyroyal or halogenated hydrocarbon poisoning, discuss with poisons/toxicologist
• Eye irritation management: Routine eye irrigation, however may require a longer duration of irrigation (oily substances). Persistent eye symptoms should have ophthalmology review
• Dermal exposure: Decontaminate area with soapy water, symptomatically treat any dermatitis/skin irritation

Ongoing care and monitoring

• Asymptomatic children with significant exposure (>5 mL) and normal vital signs including GCS, should be observed for 4 hours post exposure before discharge
• Patients with respiratory or CNS symptoms should be admitted for a longer period of observation +/- supportive care.
• Enhance elimination: ineffective
• Antidote: Nil

Consider consultation with local paediatric team when

Admission should be considered for all adolescents with an intentional overdose

Consult Victorian Poisons Information Centre 13 11 26 for advice

Consider transfer when

A child has significant CNS depression, seizures or respiratory compromise as these children usually require ongoing management in a paediatric intensive care unit

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services.

Consider discharge when

Normal GCS
Period of observation as above

Assessing risk and connecting to community services

• Prior to discharge, adolescents who present with deliberate ingestions need a risk assessment regarding the likelihood of further ingestions or other attempts to self-harm
• Assessment of other drug and alcohol use should also be undertaken
• If, after risk assessment, it is deemed safe to discharge the child or adolescent from hospital, but ongoing mental health or drug and alcohol needs are identified, they should be linked with appropriate services (see links below for services in the State of Victoria)

Discharge information and follow-up:

Parent Information: Poisoning prevention for children
Prevention of poisoning (Victorian Poisons Information Centre)

Poisons Information Centre: phone 13 11 26

Mental Health, Drug and Alcohol Services
Victoria

• Poisons Information Centre
• Child & Adolescent Mental Health Services (CAMHS): Victorian government mental health services are region-based
• Orygen Youth Health: Specialist mental health services for people aged 15 – 25 years, residing in the western and north-western regions of metropolitan Melbourne. Triage/intake - 1800 888 320.
• Headspace: National Youth Mental Health Foundation with local headspace centres
• YSAS (Youth Support and Advocacy Service): Outreach teams across Melbourne and regional Victoria for young people experiencing significant problems with alcohol and/or drug use
• YoDAA: Victoria’s Youth Drug and Alcohol Advice service - provides information and support for youth AOD needs or anyone concerned about a young person
  Infoxchange Service Seeker: Search for local community support services eg local doctor, dentist, counselling services, drug and alcohol services.

Last Updated July 2021

Reference List

1. TOXINZ Australia, DHHS. Essential Oil Blends. https://www.toxinz.com.acs.hcn.com.au. (viewed 14 April 2021).
2. Austin Clinical Toxicology Service Guideline. Hydrocarbons and Essential Oils. (viewed 14 April 2021).
3. Therapeutic Guidelines. Essential Oil poisoning. https://tgldcdp.tg.org.au.acs.hcn.com.au. (viewed 14 April 2021).
4. Lee, K et al. Essential oil exposures in Australia: analysis of cases reported to the NSW Poisons Information Centre. Medical of Journal Australia. 2020. 212(3), p132-133.