Clove oil poisoning
I was sitting in an emergency room thinking ‘tonight is so quiet’…. Wait, what? Isn’t it a horn I’m hearing? An 18yr old boy is being wheeled in a trolley, actively seizing.
(first thought-the Q word is really cursed)
Shifted the patient into the resuscitation bay, put him on left lateral, connected to oxygen and gave intramuscular Midazolam. Seizures stopped(yay!!). went out to talk to the patient’s family and to take SAMPLE history. The boy had ingested clove oil approximately 1 hour back. I have never heard of clove oil. Then the boy’s mother explained to me that it’s used for toothache. As someone who have realized the existence of a substance for the first time, I also was unaware as to how to manage clove oil poisoning. What’s the next best step? Yes, you are right- google!!!! Before getting into my phone the kid developed one more episode seizure and went into cardiac arrest. Was resuscitated and intubated. ABG showed severe mixed acidosis. And then was shifted to ICU.
1. What is clove oil?
Essential oil from dried flower buds, leaves and stems of Syzygium aromaticum or Eugenia caryophyllata and Eugenia aromaticum.
2. What are the uses of clove oil?
FDA approved as food flavoring agent, dental analgesic and is also found in dental cements, fragrance in personal care products and in aromatherapy oils and in transdermal drug delivery system.
3. What are the components of clove oil?
Eugenol (49-87%), b- caryophyllenes (4-21%), eugenyl acetate (0.5-21%)
Smaller amounts of a- humulene
4. Effects of clove oil consumption?
Eugenol is metabolized to glucuronide and sulphate conjugates by the liver. It’s shown to be hepatotoxic.
5. Is there role of activated charcoal in clove oil toxicity?
One dose of activated charcoal may be helpful in all essential oil poisoning if the airway is patent. If there is risk of seizures, do not give activated charcoal
6. what are the clinical manifestations of clove oil poisoning?
Hepatotoxicity like paracetamol toxicity, renal failure, DIC, inhalational pneumonitis, seizures, coma.
7. Mechanism of hepatotoxicity in clove oil poisoning?
Eugenol has direct cytotoxic activity. 10-30mL of eugenol is found to cause severe metabolic acidosis, respiratory depression, hepatotoxicity and coma
Liver injury arises within 12-24hours and resolves within 1-3weeks
8. Management of clove oil poisoning?
Supportive management – mechanical ventilation
Specific treatment – N- Acetyl cysteine should be initiated in all symptomatic patients
No antidotes
9. Disposition of asymptomatic patients?
Asymptomatic patients should be observed for at least 4 hours in ER
Reference
- “Clinical Practice Guidelines : Essential Oil Poisoning.” Rch.org.au, 2017, www.rch.org.au/clinicalguide/guideline_index/Essential_Oil_Poisoning/.
- “Eugenol (Clove Oil).” PubMed, National Institute of Diabetes and Digestive and Kidney Diseases, 2012, www.ncbi.nlm.nih.gov/books/NBK551727/.
- Nelson, Lewis S. Goldfrank’s Toxicologic Emergencies. New York Mcgraw-Hill Medical, 2019
