Background: Phenol is a highly toxic and corrosive compound frequently used as a disinfectant. Ingestion, whether accidental or intentional, can result in multi-system toxicity. Hematological complications, including methemoglobinemia and intravascular hemolysis, though rare, may present in a delayed fashion.
Case Presentation: We report a case of a 34-year-old female who ingested phenol with suicidal intent. Initially treated at a local facility, she presented to our emergency department two days later with nausea, vomiting, generalized weakness, and dark red urine. Clinical evaluation revealed severe anemia (Hb 4.6 g/dL), indirect hyperbilirubinemia, elevated lactate dehydrogenase, and methemoglobinemia (4.8%). Peripheral smear showed features of intravascular hemolysis. Despite hemoglobinuria, renal function remained preserved. She was managed with packed red cell transfusions, methylene blue, and supportive care. Her condition gradually improved, and she was discharged in stable condition.
Discussion: Phenol ingestion can lead to delayed hematological complications such as hemolytic anemia and methemoglobinemia, often appearing after initial stabilization. Mechanistically, oxidative damage to red blood cells and impaired oxygen delivery due to methemoglobin formation explain these findings. Unlike many reported cases complicated by acute kidney injury, this patient maintained preserved renal function despite hemoglobinuria, emphasizing the variability of presentations. Early recognition of delayed hematological effects and timely therapy with methylene blue and transfusion are critical for recovery.
Conclusion: Phenol remains a readily available toxic agent, and ingestion carries high risk of multisystem complications. Clinicians should maintain vigilance for delayed hematological manifestations and institute prompt supportive and antidotal treatment to reduce morbidity and mortality.