(P08-010-23) Hydrocarbon Poisoning Presenting With Recurrent Pneumothorax in a Child With Severe Acute Malnutrition

Objectives: Hydrocarbon poisoning causes chemical pneumonitis.However malnourished children have a greater predisposition to recurrent pneumothorax and pneumatocoeles after hydrocarbon ingestion.

Methods: A 1year7month old , severely malnourished child presented with history of unknown quantity of kerosene consumption and hurried breathing , taken to a nearby hospital. Continuous positive pressure(CPAP) ventilation was started.3 days after, child was brought with respiratory distress. Respiratory system examination revealed features suggestive of left lower lobe consolidation. Serial Xrays showed left lower lobe consolidation with left pneumothorax. Ultrasound Thorax showed bilateral empyema in addition. Child was put on CPAP ventilation. As per standard protocol, Video Assisted Thoracoscopic Surgery and decortication was done and a left Intercostal drain(ICD) was placed, gradually weaned off CPAP and discharged on nutritional rehabilitation. In the first two weeks after hospitalisation, the child’s nutritional status did not significantly improve. A recurrence of left tension pneumothorax occurred at two weeks form the day of hospitalisation and was relieved by intercostal drainage. Parents were counselled in detail regarding the diet and the child was monitored in hospital during the nutritional rehabilitation. Post discharge, the child was readmitted twice in the next 3 weeks for recurrent pneumothorax, each time resolving with ICD. Aggressive nutritional rehabilitation was continued. From 1 month post discharge there was no recurrence. Child was gaining weight gradually and fell into Moderate Acute Malnutrition (Weight for Age between -2 to -3 Standard Deviations) from Severe Acute Malnutrition(Weight for Age < -3Standard Deviations) and eventually became a normal child.

Results: Hydrocarbon pneumonitis tends to be more complicated with significant malnutrition. Here the severely malnourished child presented with recurrent pneumothorax post hydrocarbon pneumonitis .Once nutritional rehabilitation was complete, the lung problem resolved. Significant malnutrition worsens the damage caused by the hydrocarbon possibly because of epithelial thinning in the lungs.

Conclusions: Providing a nutritious diet to the child is essential in preventing malnutrition and complications of relatively benign conditions.

Funding Sources: None