Document Type : Case Report
Authors
1 DNB Resident, Department of Internal Medicine, Max Super Specialty Hospital, Vaishali, Ghaziabad, India
2 Department of Internal Medicine, Max Super Specialty Hospital, Vaishali, Ghaziabad, India
Abstract
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.
Keywords
Main Subjects
- Bisset NG. Phenol. In: Hazardous Chemicals: Safety Management and Global Regulations. Berlin: Springer; 2005. p. 183–5.
- Reddy KSN. The essentials of forensic medicine and toxicology. 34th ed. New Delhi: Jaypee Brothers; 2017. p. 557–8.
- Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological profile for phenol. Atlanta (GA): U.S. Department of Health and Human Services; 2008.
- Acharya S, Bhatta R. Pattern of acute poisoning cases in a tertiary care hospital in western Nepal. Nepal J Med Sci. 2015;4(2):110–4.
- Cassidy MK, Houston JB. In vivo capacity of hepatic and extrahepatic enzymes to conjugate phenol. Drug Metab Dispos. 1984;12(5):619–24.
- Merliss RR. Phenol marasmus. J Occup Med. 1972;14(1):55–6.
- Bruce RM, Santodonato J, Neal MW. Summary review of the health effects associated with phenol. Toxicol Ind Health. 1987;3(4):535–68.
- Chand Meena M, Band R, Sharma G. Phenol and its toxicity: a case report. Indian J Toxicol. 2015;8(27):1222–4.
- Barker SJ, Tremper KK, Hyatt J. Effects of methemoglobinemia on pulse oximetry. Anesthesiology. 1989;70(1):112–7.
- Santa N, Bhagyabati S, Jeetenkumar T, Motu T, Lokeshwar K, Singh MK. Phenol-induced haemolytic anaemia. J Appl Hematol. 2003;4(2):174–5.
- Rehman HU. Methemoglobinemia. West J Med. 2001;175(3):193–6.
- Foxall PJ, Bending MR, Gartland KP, Nicholson JK. Acute renal failure following accidental cutaneous absorption of phenol. Hum Toxicol. 1989;8(6):491–6.
- Tyagi A, Tyagi S, Malik N, Chawla H. Suicidal phenol ingestion: a case report. IP Int J Forensic Med Toxicol Sci. 2017;2(1):22–3.
- Todorović V. Akutna trovanja fenolom [Acute phenol poisoning]. Med Pregl. 2003;56 Suppl 1:37–41. Serbian.
- Dell’Acqua C, Pronczuk J. Poisons information monograph: brodifacoum. Geneva: IPCS; 1999.
- Seak CK, Lin CC, Seak CJ, Hsu TY, Chang CC. A case of black urine and dark skin: cresol poisoning. Clin Toxicol (Phila). 2010;48(9):959–60.
- Phenols – sources and toxicity. Pol J Environ Stud. 2007;16(3):347–62.
)