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

Key points

Eucalyptus oil is highly toxic. Small ingestions of pure oil (≥5 mL) can lead to severe symptoms
Symptom onset is usually rapid (within 30 mins) but can be delayed up to 4 hours after exposure
CNS depression and respiratory compromise are the main features of eucalyptus oil poisoning to monitor for

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

Background

Eucalyptus oil is a popular household product, commonly presented as an essential oil, medicinal product, cleaning product, inhalational/vaporiser fluid or topical preparation

Pharmacokinetics
Onset: Within 30 mins to 4 hours post ingestion
Duration of symptoms: usually resolve within 24 hours

Dose related toxicity
Small ingestions of pure oil can lead to severe symptoms. A dose of 2-3 mL can induce mild CNS depression with drowsiness and/or dizziness and ataxia. A dose of ≥5 mL can induce significant CNS depression with coma

Children requiring assessment

All patients with deliberate self-poisoning or significant accidental ingestion
Any symptomatic patient
Single dose ingestion of >5mL
Children where 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
Route of exposure: eg inhalation, ingestion, intranasal, topical (consider frequent, repeated topical applications)
Preparation type: if possible determine the exact name and % solution (2-3 mL is significant in a child whilst >5 mL may be associated with severe toxicity).
Co-ingestants: eg paracetamol, other essential oils

Examination

CNS: Miosis or mydriasis (miosis more commonly), myoclonus, CNS depression (drowsiness and dizziness with small exposures, ataxia, seizures, coma with larger (≥5 mL) exposures)
CVS: Tachycardia, hypotension
Respiratory: Depression, apnoea, bronchospasm, signs of aspiration pneumonitis
GIT: Nausea, vomiting and diarrhoea(early symptoms), epigastric pain
Skin: Irritation, contact dermatitis

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

Consider:

Chest X-ray and blood gas if signs of aspiration pneumonitis
UEC and LFT in children with significant illness or large ingestions (≥5 mL)
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. May require non-invasive ventilation or intubation if severe. Corticosteroids and prophylactic antibiotics are not indicated
Fever is common following aspiration with pneumonitis, therefore antibiotics should be withheld until there is objective evidence of bacterial infection

2. Decontamination
Charcoal is contraindicated due to risk of aspiration

Ongoing care and monitoring

Asymptomatic children with significant exposure and normal vital signs, including normal GCS, should be observed for 4 hours post exposure before discharge
Symptomatic patients should be admitted for a longer period of observation +/- supportive care
Enhanced elimination: ineffective
Antidote: Nil

Consider consultation with local paediatric team when

Mental health assessment and admission should be considered for all adolescent patients with an intentional overdose.

Consult Victorian Poisons Information Centre 13 11 26 for advice

Consider transfer when

Significant CNS depression, seizures or respiratory compromise requiring management in a paediatric intensive care unit

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

Consider discharge when

Normal GCS
No respiratory symptoms
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 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

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

TOXINZ Australia, DHHS. Eucalyptus Oil. (viewed 14 April 2021)
Austin Clinical Toxicology Service Guideline. Hydrocarbons and Essential Oils. (viewed 14 April 2021).
Therapeutic Guidelines: Essential Oil poisoning. (viewed 14 April 2021).
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.