Phenol (C(6)H(5)-OH)
CAS: 108-95-2; UN 1671 (solid), 2312(molten), 2821 (solution) Synonyms include carbolic acid, hydroxybenzene, monohydroxyl benzene, benzenol, monophenol, phenyl hydroxide, phenyl alcohol, phenic acid, phenylic acid, and phenylic alcohol.
- Victims exposed to phenol vapor only do not pose a significant risk of secondary contamination. However, victims whose clothing or skin is contaminated with liquid phenol can secondarily contaminate personnel by direct contact or through off-gassing vapor.
- Phenol is a flammable, combustible, and highly corrosive chemical that can cause serious burns and systemic poisoning by all exposure routes.
- Introduced originally as an antiseptic, phenol is still used in small amounts in disinfectants, insecticides, and many over-the-counter products that have antiseptic qualities.
Description -
At room temperature, phenol is a translucent, colorless, crystalline mass, white powder, or thick, syrupy liquid. The crystals are hygroscopic and turn pink to red in air. When pure, phenol has a sweet, tar-like odor that is readily detected at low concentrations (0.05 ppm in air). It is soluble in alcohol, glycerol, petrolatum and, to a lesser extent, water.
Routes of Exposure --
Inhalation -
Phenol is absorbed rapidly by all routes. Because of phenol's low volatility, inhalation hazard is limited. The odor threshold of phenol is sufficiently low to provide adequate warning of dangerous concentrations.
Skin/Eye Contact -
Acute toxic effects most often occur by skin contact. Even dilute solutions (1% to 2%) may cause severe bums if contact is prolonged. Systemic toxicity can result from skin or eye exposures. Phenol vapor and liquid penetrate the skin with an absorption efficiency approximately equal to the absorption efficiency by inhalation. In one case, death occurred within 30 minutes of skin contact.
Ingestion -
Accidental and intentional ingestions of phenol have been reported. As little as 50 to 500 mg has been fatal in infants. Deaths in adults have resulted after ingestions of 1 to 32 g.
Properties -
Description: Colorless to pink crystalline mass or white powder, syrupy liquid
Warning properties: adequate; sweet, acrid odor at > 0.05 ppm
OSHA PEL (Permissible Exposure Limit) = 5 ppm (averaged over an 8-hour workshift) [Skin]
NIOSH IDLH (Immediately Dangerous to Life and Health) = 250 ppm
AIHA ERPG-2 (emergency response program guideline)= 50 ppm
Molecular weight = 94.1 daltons
Melting point = 104.9 degrees F (43 degrees C)
Boiling point (760 mm Hg) = 359 degrees F (182 degrees C)
Vapor pressure at 67.1 degrees F (20 degrees C) = 0.36 mm Hg
Gas density = 3.24 (air = 1)
Water solubility = 9% at 77 degrees F (25 degrees C); hygroscopic
Flammable range = 1.7% to 8.6% (concentration in air); combustible solid
Sources/Uses -
Phenol is obtained by fractional distillation of coal tar and by organic synthesis. By far, its largest single use is in manufacture of phenolic resins and plastics. Other uses include manufacture of explosives, fertilizers, paints, rubber, textiles, adhesives, drugs, paper, soap, wood preservatives, and photographic developers. When mixed with slaked lime and other reagents, phenol is an effective disinfectant for toilets, stables, cesspools, floors, drains, etc.
Phenol was once an important antiseptic and is still used as a preservative in injectables. It also is used as an antipruritic, a cauterizing agent, a topical anesthetic, and as a chemical skin peeler (chemexfoliant). It can be found in low concentrations in many over-the-counter products including preparations for treatment of localized skin disorders (Castellani's paint, PRID salve, CamphoPhenique lotion), in topical preparations (Sting-Eze), and in throat sprays and lozenges (Chloraseptic, Ambesol, Cepastat, Cheracol).
Health Effects
- Exposure to phenol by any route can produce systemic poisoning. Initially, central nervous system (CNS) stimulation may result, followed rapidly by CNS depression. Coma and seizures can occur within minutes of exposure or may be delayed up to 18 hours.
- Phenol is corrosive and causes chemical burns at the contact site.
Acute Exposure -
Mechanism of Injury. As a corrosive substance, phenol denatures proteins and generally acts as a protoplasmic poison. Systemic poisoning can occur after inhalation, skin contact, eye contact, or ingestion. Typically, transient central nervous system (CNS) excitation occurs, then profound CNS depression ensues rapidly. Metabolic acidosis and acute renal failure may complicate the condition.
Neurologic -
Initial signs and symptoms may include nausea, diaphoresis, headache, dizziness, and tinnitus. Seizures, coma, respiratory depression, and death may ensue quickly. Coma and seizures usually occur within minutes to a few hours after exposure or after a delay of up to 18 hours. Phenol also may cause demyelination and axonal damage of peripheral nerves.
Cardiovascular -
Phenol exposure causes initial blood pressure elevation, then progressively severe hypotension and shock.
Cardiac dysrhythmias occasionally have been described in poisoned patients, most often in persons undergoing chemexfoliation (chemical skin-peeling). Atrial and ventricular dysrhythmias have been noted.
Respiratory -
Mild exposure may cause upper respiratory irritation. With more serious exposure, laryngeal edema, inflammation and ulceration of the trachea, and pulmonary edema can occur.
Gastrointestinal -
Vomiting and diarrhea are common effects of phenol toxicity by any route. In cases of ingestion, diffuse corrosive mucosal injury can involve the entire intestinal tract, sometimes causing significant ulceration and bleeding. Ingestion may lead to death from respiratory failure.
Renal -
Renal failure has been reported in acute poisoning. Urinalysis may reveal a green to brown discoloration of the urine, albuminuria, and casts.
Hematologic -
Acute hemolysis has been associated with severe phenol toxicity. Methemoglobinemia has been reported in infants.
Ocular -
Contact with concentrated phenol solutions can cause severe ocular damage including corneal opacification, if it is, and palpebral bums.
Dermal -
When phenol is applied directly to skin, a white pellicle of precipitated protein forms. This soon tums red and eventually sloughs, leaving the surface stained slightly brown. If phenol is left on the skin, it will penetrate rapidly and lead to necrosis and gangrene. If more than 60 square inches is affected, there is risk of imminent death. Phenol appears to have local anesthetic properties and may cause extensive damage before pain is felt.
Potential Sequelae -
Chronic neuropathy has been reported as a result of acute exposure. Chronic skin and eye effects may result from chemical bums.
Phenol ingestion may lead to esophageal strictures.
Chronic Exposure --
Repeated phenol exposure in the workplace has caused renal damage including nephritis, edema of the convoluted tubules, cloudy swelling of the tubular cells, and degenerative changes in glomeruli. Liver damage and pigment changes of the skin have been noted in some workers. Chronic exposure also has been correlated with an increased risk of ischemic heart disease in workers.
Carcinogenicity -
Insufficient evidence exists to classify phenol as a carcinogen in humans or animals.
Reproductive and Developmental Effects -
Phenol has been reported to be embryotoxic or fetotoxic, but not teratogenic. In humans, no clear association between phenol exposure and risk for birth defects is found; in experimental animals, phenol has generally not caused developmental effects except at doses that also caused maternal toxicity.
Prehospital Management
- Victims exposed to phenol vapor only do not pose a significant risk of secondary contamination. However, victims whose clothing or skin is contaminated with liquid phenol can secondarily contaminate personnel by direct contact or through off-gassing vapor 'from heavily soaked clothing or from vomitus of victims who have ingested phenol.
- Phenol may cause convulsions, sudden collapse, and coma. Because of its corrosivity, contact causes severe chemical burns.
- Rapid decontamination may affect greatly the odds of survival.
- There is no specific antidote for phenol poisoning. Treatment is supportive.
Hot Zone -
Note. Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained to use it, call for assistance from a local or regional hazmat team or other properly equipped response organization.
Rescuer Protection -
Rescuers in the Hot Zone should wear self-contained breathing apparatus (SCBA). Chemical-protective clothing and gloves are required if contact with liquid phenol or its concentrated vapors is possible.
ABCs -
Quickly ensure a patent airway. Stabilize the cervical spine with a collar if trauma is suspected. Administer supplemental oxygen and assist ventilation with a bag-valve-mask device if necessary.
Victim Removal -
If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. If victims are unable to walk, remove them on a backboard or gurney. If there is no other means of transport, carefully carry or drag victims to safety.
Decontamination Zone --
Note. Victims with exposure to only vapors of phenol and with no skin or eye irritation do not need decontamination. They may be transferred immediately to the Support Zone. For all others, see Basic Decontamination.
Rescuer Protection -
Rescuers in the decontamination zone should wear self-contained breathing apparatus (SCBA) and chemical-protective clothing and gloves if they will be caring for victims with phenol-soaked clothing or skin. If the proper equipment is not available, or if rescuers have not been trained to use it, call for assistance from a local or regional hazmat team or other properly equipped response organization. If the decontamination area is outdoors and has good natural ventilation, a lesser level of respiratory protection may suffice.
ABCs -
Quickly ensure a patent airway. Stabilize the cervical spine with a collar if trauma is suspected. Supplemental oxygen may be administered if available.
Basic Decontamination -
Rapid skin decontamination is critical. Remove and double-bag contaminated clothing. Patients who are able and cooperative may assist with their own decontamination. Flu sh exposed skin and hair with plain water for 2 to 3 minutes, then wash with mild soap or shampoo and rinse with copious water. If immediately available, use polyviny pyrrolidone (PVP), polyethylene glycol (PEG 300 or PEG 400), glycerol, or vegetable oil to assist removal of phenol from exposed skin. Isopropyl alcohol may be used for small bums, but caution should be used since isopropyl alcohol toxicity may occur.
Note: Some investigators suggest that a water paste of polyvinyl pyrrolidone (PVP) is superior to PEG for skin decontamination and detoxification because PVP has the ability to form a complex with phenol.
Flush exposed or irritated eyes with plain water or saline for 3 to 5 minutes. Remove contact lenses if present.
In case of phenol ingestion, do not induce emesis. If the patient is alert and able to swallow, administer a glass of plain water, then administer a slurry of activated charcoal (adult dose: 50 to 100 g).
Transfer to Support Zone -
As soon as basic decontamination is completed, move the patient to the Support Zone.
Support Zone -
Note. Be certain that patients have undergone basic decontamination (see Decontamination Zone above). Patients who have undergone proper decontamination or who have been exposed to only vapors pose no serious risk of causing secondary contamination. Support Zone personnel require no specialized protective gear in such Cases
ABCs -
Quickly ensure a patent airway. Stabilize the cervical spine with a collar if trauma is suspected. Administer supplemental oxygen and assist ventilation with a bag-valve-mask device if necessary. Establish intravenous access in all seriously symptomatic patients and attach a cardiac monitor.
Advanced Treatment -
Intubate the trachea if indicated (as in cases of respiratory compromise). When endotracheal intubation cannot be performed due to airway obstruction, perform cricothyroidotomy if equipped and trained to do so.
Treat hypotension and seizures according to ALS protocol.
Additional Decontamination -
If skin or eyes remain irritated, flush with plain water or saline for 3 to 5 minutes.
Remove contact lenses if present. For patients with significant skin exposure, it may be necessary to repeat the soap or shampoo wash, or to continue using PVP, PEG or other solvents as described in Decontamination Zone.
In case of phenol ingestion, do not induce emesis. If the patient is alert and able to swallow, administer a glass of plain water. If it has not been done earlier, administer a slurry of activated charcoal (adult dose: 50 to 100 g).
Transport to Medical Facility -
Report to the base station and the receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility.
If a patient has ingested phenol, prepare the ambulance for possible vomiting of toxic material. Have ready several towels and opened plastic bags to quickly clean up and isolate vomitus.
Multi-Casualty Triage -
Note. If possible, consult with the base station physician or regional poison control center for advice regarding triage of multiple victims.
Persons with severe inhalation exposure, or skin bums over a large body surface area, or persons who have ingested phenol, or have experienced serious symptoms such as syncope or convulsions, need to be evaluated at a medical facility. (The severity of exposure can be estimated by the concentration of phenol and the amount and duration of contact.)
Persons who have had exposure to phenol vapor only and are asymptomatic are not likely to develop complications. After recording their names, addresses, and telephone numbers, they may be released from the scene with follow-up instructions.
Emergency Department Management
- Hospital personnel in an enclosed area can be secondarily contaminated by vapor offgassing from heavily soaked clothing or from the vomitus of victims who have ingested phenol. Patients do not pose a contamination risk after contaminated clothing is removed and the skin is washed.
- Phenol may cause convulsions, sudden collapse, and coma. Because of its corrosive nature, contact can cause severe chemical burns.
- There is no specific antidote for phenol poisoning. Treatment consists of supportive measures.
Decontamination Area --
Note. Patients with exposure to vapors of phenol only and with no skin or eye irritation do not need decontamination. They can be transferred immediately to the Critical Care Area. Other patients will require decontamination as described below.
ABCs -
Evaluate and support airway, breathing, and circulation. Watch for signs of laryngeal edema and airway compromise. Monitor cardiac rhythm.
Treat seizures in the conventional manner. Manage hypotension and shock with IV fluids; pressor agents may be required.
Basic Decontamination -
Rapid skin decontamination is critical. If the patient has not been decontaminated, perform the decontamination procedure immediately. Patients exposed to only vapor do not require decontamination unless they have skin or eye irritation.
Since contacting clothing or skin wet with phenol may cause bums, ED staff should don chemical-resistant jumpsuits (e.g., of Tyvek, Saranex) or butyl rubber aprons, rubber gloves, and eye protection. After the patient has
been decontaminated, no special protective clothing or equipment is required for ED personnel.
If the patient's clothing is wet with phenol, quickly remove and double-bag the contaminated clothing and all personal belongings while cleansing the skin. Thoroughly wash the skin with soap or mild detergent and copious water. If immediately available, use a water paste of polyvinyl pyrrolidone (PVP), polyethylene glycol (PEG 300 or PEG 400), glycerol, or vegetable oil to assist removal of phenol from exposed skin.
Some investigators suggest that PVP is superior to PEG for skin decontamination and detoxification because PVP has the ability to form a complex with phenol. If PVP, PEG, glycerol, or olive oil are not available immediately, a water wash using copious water (preferably under a shower) should be continued.
Remove contact lenses and irrigate exposed eyes with water for at least 15 to 30 minutes. An ophthalmic anesthetic, such as 0.5% tetracaine, may be necessary to alleviate blepharospasm, and lid retractors may be required to allow adequate irrigation under the eyelids.
Critical Care Area -
Note. Be certain that appropriate decontamination has been carried out. See Basic Decontamination.
ABCs -
Evaluate and support airway, breathing, and circulation. Continuously monitor cardiac rhythm.
Treat hypotension, seizures, and ventricular arrhythmias in the conventional manner. Patients with significant and persistent CNS depression should be evaluated for the presence of intercurrent disorders (such as trauma, hypoglycemia, or drug intoxication).
Inhalation Exposure -
Administer supplemental oxygen by mask to patients with respiratory complaints. Patients in respiratory distress or with abnormal pulmonary examination may require chest radiography and ABGs.
Skin Exposure -
If the skin contacted liquid phenol, chemical burns may result. Treat chemical burns as thermal burns.
Eye Exposure -
If eye irritation or injury is evident, test visual acuity and examine the eyes for corneal damage using a magnifying device or a slit lamp and fluorescein staining. Small corneal defects may be treated with ophthalmic antibiotic ointment or drops and analgesic medication. Immediately consult an ophthalmologist for patients with severe corneal injury.
Ingestion Exposure -
Do not induce emesis because the patient is at risk of abrupt seizures and coma. If the patient has ingested a large dose of phenol, perform gastric lavage with a small bore tube, then administer activated charcoal and a cathartic. When small amounts of phenol have been ingested, gastric emptying
may not be necessary if activated charcoal can be given promptly.
Consider endoscopy to evaluate the extent of corrosive injury to the gastrointestinal tract.
Antidotes and Other Treatments -
There is no specific antidote for phenol poisoning. Although charcoal hemoperfusion can remove free phenol from the blood and exchange transfusion has been suggested for phenol poisoning, the clinical value of these procedures is unproven.
Laboratory Tests -
Depending on the initial evaluation, useful tests might include CBC, glucose, electrolytes, renal function tests (BUN, creatinine, urinalysis), and ECG monitoring. Chest radiography and ABGs also are recommended for severe inhalation exposure or if pulmonary aspiration is suspected. Urinary phenol levels above 80 mg/L suggest overexposure.
Disposition and Follow-up --
Hospitalization should be considered for patients with evidence of systemic toxicity from any route of exposure.
Delayed Effects -
Because pulmonary edema or CNS effects may be delayed, patients with suspected serious exposure should be observed and reexamined periodically for 18 to 24 hours.
Patient Release -
Patients with mild exposure who are initially asymptomatic should be observed for 4 to 6 hours, then discharged if no symptoms occur during this period. Advise discharged patients to rest and to seek medical care promptly if symptoms develop. (For a list of symptoms, see the reverse side of Phenol Patient Information Sheet.)
Follow-up -
Patients with skin or eye burns who have been released should be reevaluated in 24 hours.
Reporting --
If a work-related incident has occurred, you may be legally required to file a report; contact your state or local health department. Other persons may still be at risk in the setting where this incident occurred. If the incident occurred in the workplace, contact the employer or OSHA for assistance in evaluating workplace conditions. An appropriate public agency can be notified if a public health risk exists. If appropriate, inform patients that they may request an evaluation of their workplace from NIOSH. See Appendix III for a list of these and other agencies that may be of assistance.
Phenol Patient Information Sheet
This handout provides information and follow-up instructions for persons who may have been exposed to phenol liquid or vapor.
What is phenol?
Phenol may be found as a translucent, clear or light-pink crystalline mass; a white powder;, or a clear liquid. It has a sweet, sharp odor. Phenol is used in many commercially available products including plastics, resins, fertilizers, paints, photographic developers, and some medicines.
What immediate health effects may result from exposure to phenol? Poisoning can occur when phenol gets on the skin or in the eyes, when it is inhaled, and when it is swallowed. Skin and eyes can be mildly or severely burned, depending on how much and how long the phenol was contacted. Breathing phenol vapors can bum the lining of the nose, throat, and lungs, just like it bums the skin. Severe injury to the lungs can cause them to fill with fluid, making breathing difficult. Swallowing phenol bums the lining of the digestive tract and can result in internal bleeding. Phenol is absorbed easily into the body through the skin, lungs, and stomach. The brain is very sensitive to phenol. Phenol can cause seizures and coma and may interfere with the brain's control of normal heart beat and regular breathing patterns. It can cause dangerous rhythm changes in the heart.
What is the treatment for phenol poisoning?
There is no antidote for phenol poisoning, but its effects can be treated and most exposed persons do get well. Persons who have had a serious exposure may need to be hospitalized for 24 hours.
Are any future health effects likely to occur?
After a single, small exposure, no delayed or long-term effects are likely to occur. After a severe exposure, you may not notice any symptoms for up to 24 hours. The reverse side of this page lists some signs and symptoms to watch for--if any of them occur, seek medical care.
What tests can be done if a person has been exposed to phenol? Depending on the severity of symptoms, the doctor may order blood tests, urine tests, chest X ray, and a heart monitoring test. These tests may show if damage has been done to the heart, kidneys, lungs, or nervous system. Abnormally high amounts of phenol may be found in the urine if exposure was severe. Testing is not needed in every case. If phenol got in your eyes, the doctor may have put an orange dye in your eyes and examined them with a magnifying lamp. If you swallowed phenol, you may have been given a solution containing charcoal, which will soak up phenol in your stomach.
Where can more information about phenol be found?
More information about phenol may be obtained from your regional poison control center, your state, county, or local health department; the Agency for Toxic Substances and Disease Registry (ATSDR); your doctor; or a clinic in your area that specializes in occupational and environmental health. If the exposure happened at work, you may wish to contact your employer, the Occupational Safety and Health Administration (OSHA) or the National Institute for Occupational Safety and Health (NIOSH). Ask the person who gave you this form for help in locating these telephone numbers.
Phenol Follow-up --
( ) Call your doctor or the Emergency Department if you develop any of the following symptoms within the next 24 hours: * coughing or wheezing * difficulty breathing or shortness of breath, chest pain * irregular heartbeats, pounding, or fluttering in your chest * increased pain, swelling, redness or discharge where skin is burned * unexplained drowsiness * fever or headache * fatigue or flu-like symptoms ( ) No follow-up appointment is necessary unless you develop any of the symptoms described above. ( ) Call for an appointment with Dr. _________ in the practice of_________. When you call for your appointment, please tell the receptionist/nurse that you were treated in the Emergency Department at__________________ Hospital by __________ and were advised to be seen again in __ days. ( ) Return to the Emergency Department/__________Clinic on (date)__________ at____ AM/PM for a follow-up examination. ( ) Do not perform vigorous physical activities for 1 to 2 days. ( ) You may resume everyday activities including driving and operating machinery. ( ) Do not return to work for __ days. ( ) You may return to work on a limited basis. See instructions below. ( ) Avoid exposure to cigarette smoke for 72 hours since smoke may worsen injury to your lungs. ( ) Avoid drinking alcoholic beverages or taking aspirin for 24 hours since these substances may aggravate injury to your stomach lining or may have other effects. ( ) You may continue taking the following medication(s) that your doctor(s) prescribed for you:____________________________________________________ ______________________________________________________________________ ( ) Other instructions:____________________________________________________ _______________________________________________________________________ Signature of patient _______________________ Date _________________________ Signature of physician _____________________ Date _________________________
Above courtesy of C.D.C.
