Phenol, also known as carbolic acid, is one of the oldest antiseptics. Phenol is also a component (0.1-4.5%) of various lotions, ointments, gels, gargles, lozenges, and throat sprays (Chap. 53). Although many cases of phenol poisoning were reported in the past, acute oral overdoses of phenol-containing solutions are relatively rare today. Phenol is a caustic that causes cell wall disruption, protein denaturation, and coagulation necrosis. It also acts a central nervous system stimulant. Severe dermal burns from phenol have resulted in systemic toxicity and even death within minutes to hours. Parenteral administration of phenol can also be lethal at a dose of as little as 1 g.

CNS effects include central stimulation, seizures, lethargy, and coma. Cardiac symptoms from phenol include tachycardia, bradycardia, and hypotension. Other systemic symptoms that may develop include pulmonary disturbances, hypothermia, metabolic acidosis, methemoglobinemia, and rabbit syndrome. Local toxicity to the GI tract from the ingestion of phenol may result in nausea, vomiting, bloody diarrhea, and severe abdominal pain. Dermal exposures to phenol usually result in a light brown staining of the skin.

A variety of treatments have been suggested for dermal and gastric decontamination of phenol. Low-molecular-weight polyethylene glycol solution (PEG 300 or 400) is the most effective decontaminating agent. Water is currently recommended for dermal irrigation and careful gastric decontamination. Water is a reasonable choice if PEG is unavailable. Supportive care is the mainstay of therapy for systemic toxicity.

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