See also: [[paeds tox]], [RCH - essential Oils](https://www.rch.org.au/clinicalguide/guideline_index/Essential_Oil_Poisoning/), [[Hydrocarbons]], [[Solvents]]
#paeds
>Charcoal is contraindicated due to risk of aspiration and due to the fact essential oils are rapidly absorbed.
| **Essential Oil** | **Clinical manifestations** |
| --------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Clove <br>*Requires urgent discussion with toxicologist* | Large ingestions can have hepatotoxicity similar to paracetamol poisoning, renal failure, DIC, inhalational pneumonitis, coma |
| Fennel | Nausea, vomiting, seizure activity, pulmonary oedema |
| Geranium | Allergic contact cheilitis |
| Lavender | CNS depression, ataxia, photosensitiser that promotes hyperpigmentation, contact dermatitis |
| Lemon myrtle | Skin irritation and corrosion |
| Nutmeg | hallucinations, coma |
| Pennyroyal <br>*Requires urgent discussion with toxicologist* | Nausea, vomiting, abdominal pain, lethargy, agitation, dizziness and weakness. Large ingestions can have hepatotoxicity similar to paracetamol poisoning, renal failure, DIC, coma |
| Thuja <br>(Wormwood plant of the cedar family) | Multiple tonic-clonic seizures |
| Wintergreen <br>(98% Methyl Salicylate) | Nausea, vomiting, tinnitus, vertigo, hyperventilation, [[Seizure (paediatric)\|seizures]]. A dose as small as 1-2 mL can be toxic (see [[Aspirin overdose\|Salicylates]]) |
| Wormwood | Acidosis, acute renal failure, respiratory acidosis, rhabdomyolysis, visual alterations, delirium, restlessness, paranoia, tremor, seizures |
| Eucalyptus | See [[#Eucalyptus oil]] |
# general care principles
Charcoal is contraindicated due to risk of aspiration and due to the fact essential oils are rapidly absorbed.
- **Specific treatments:** Consider [[N-acetyl-cysteine|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
- 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
# special cases
## Eucalyptus oil
> [!key points]
> 1. Eucalyptus oil is highly toxic. Small ingestions of pure oil (≥5 mL) can lead to severe symptoms
> 2. Symptom onset is usually rapid (within 30 mins) but can be delayed up to 4 hours after exposure
> 3. CNS depression and respiratory compromise are the main features of eucalyptus oil poisoning to monitor for
>
> >**assess:**
> >- 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
**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
**Dispo:**
- 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