Lizol Ingestion - Poisoning (Carbolism)

• Park's Textbook of Preventive and Social Medicine: "Cresol emulsified with soap is known as 'saponified cresol'. Lysol...are cresol emulsions. Lysol contains 50-60%..."
• P C Dikshit Forensic Medicine: "Lysol is as dangerous as phenol."

Composition

• Active ingredient: Cresol 50-60% (saponified/emulsified in soap)
• Cresol is a mixture of ortho-, meta-, and para-cresol (methylphenol derivatives)
• Acts similarly to carbolic acid but is a contact/caustic + systemic poison

Fatal Dose and Period

• Fatal dose: 10-15 g (pure phenol); ~20 drops of pure phenol can be lethal; approximately twice this amount of commercial carbolic disinfectants like Lizol
• Fatal period: 3-4 hours (range: 3 minutes to 60 hours)

Mechanism of Action

1. Local (corrosive): Coagulates proteins without forming a stable chemical bond - gives phenol remarkable penetrating power. Causes necrosis and sloughing of mucosal surfaces, burns skin/mucous membranes producing a white eschar that turns brown
2. Systemic (narcotic/CNS depressant): Rapidly absorbed from GI tract, skin, rectum, and respiratory tract - depresses the CNS causing rapid unconsciousness and coma
3. Methemoglobin formation in severe cases (hydroquinone metabolite)
4. Nephrotoxicity - hemorrhagic nephritis if the patient survives more than 48 hours

• Rosen's Emergency Medicine, Parikh's Forensic Medicine and Toxicology

Clinical Features

• Burning sensation from mouth to stomach - initially burning, then tingling and anaesthesia (numbing effect often suppresses vomiting)
• Lips, mouth, tongue: corroded, white, bleached, hardened burns → later become brown, slough off
• Dysphagia, painful swallowing and speech
• Nausea, vomiting (may be absent due to anaesthetic effect on stomach)
• Abdominal pain

• Giddiness → rapid unconsciousness → coma
• Skin cold and clammy, pallor/cyanosis
• Pupils constricted (miosis) - can mimic opium poisoning
• Pulse: rapid, feeble, thready
• Temperature: subnormal (hypothermia)
• Respiration: slow, laboured, stertorous
• Characteristic phenolic odour of breath, vomit, urine
• Convulsions, lockjaw (trismus)
• Circulatory collapse and shock

• Carboluria - urine is scanty, initially normal in colour, turns dark olive-green on standing (due to oxidation of hydroquinone and pyrocatechol metabolites in air)
• Oliguria/anuria, haematuria, proteinuria, casts

Postmortem Appearances

• External: Grayish-white/dark brown burns at angles of mouth, chin; smell of phenol
• Mouth: White swollen tongue; corroded, hardened mucosa
• Oesophagus: Tough, white-gray, corrugated mucosa in longitudinal folds
• Stomach: Leathery, thickened, brownish mucosa with prominent rugae; dark brown mucoid contents with phenolic smell; underlying mucosa dark red and necrotic
• Kidneys: Parenchymal degenerative changes, hemorrhagic nephritis
• Liver/spleen: White hardened patches from phenol transudation through stomach wall
• Lungs/brain: Congested
• Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology; P C Dikshit Textbook of Forensic Medicine

Management

Immediate Steps (ABCDE)

• Airway: Secure early - risk of laryngeal/glottic oedema and aspiration. Consider early intubation if respiratory distress
• Breathing: Oxygen inhalation, assisted ventilation if needed
• Circulation: IV access, treat circulatory collapse

Decontamination

• Oral activated charcoal (100 g in adults) if within 1 hour of ingestion, patient alert and cooperative
• Gastric lavage: Pass soft stomach tube carefully (corrosion less severe than mineral acids; tissues hardened). Lavage with:
  • Warm water + activated charcoal, OR
  • 10% glycerine in water, OR
  • Soap solution, OR
  • Water + magnesium sulphate (forms insoluble sulphocarbolate)
  • Continue until washings are clear and odourless
  • Leave ~1-2 oz liquid paraffin or castor oil in stomach after lavage
• Skin exposure: Remove clothing; wash with soap and water; apply castor oil to burns
• Do NOT induce vomiting (emetics often fail due to anaesthetic effect; aspiration risk)

Supportive Care

• IV fluids: Crystalloid + sodium bicarbonate (alkalinises urine, promotes phenol excretion, combats acidosis) - IV saline with 7 g/L sodium bicarbonate
• Demulcents: Milk, egg white (orally)
• Hypothermia: Active warming (phenol causes temperature drop)
• Hyperthermia (if substituted phenols/dinitrophenol component): Evaporative cooling, cold IV fluids, ice packs
• Seizures/agitation: Benzodiazepines - lorazepam 1-2 mg IV or diazepam 5-10 mg IV
• Methemoglobinaemia: Methylene blue if significant

Monitoring and Investigations

• Serum electrolytes, renal function (BUN/creatinine)
• Liver function tests
• Creatine kinase (rhabdomyolysis)
• ECG, cardiac troponins (myocardial injury risk)
• Urine for carboluria (dark olive-green on standing)
• Ferric chloride test on urine: turns blue in presence of phenol

Disposition

• Any symptomatic patient: admit to ICU for intensive cardiac and neurological monitoring
• Asymptomatic patients: observe for 8-12 hours; discharge if remains asymptomatic
• Rosen's Emergency Medicine, Parikh's Forensic Medicine and Toxicology, P C Dikshit Forensic Medicine and Toxicology

Key Distinguishing/Exam Points