kerosene aspiration, aspiration pneumonia :causes & remedy

1. Submitted to – Dr. Ankur sharma
Submitted by – Prince chauhan

2. ASPIRATION PNEUMONIA
INTRODUCTION
Aspiration is defined as the inhalation of foreign
material into the airways beyond the vocal cords.
The content of the aspirate is variable and may
comprise secretions, blood, bacteria, liquids and food
particles.
Most aspirates in the clinical scenarios are liquid in
nature. It is the composition of the aspirate that
determines the extent and progression of the injury
on the pulmonary parenchyma.

3. Predisposing Factors
Altered level of consciousness
• stroke
• seizures
• intoxication (alcohol and other drugs)
• head trauma
• anaesthesia

4. Predisposing Factors
 Mechanical disruption of usual
defences
• nasogastric tube
• Cleft palate
• Endotracheal intubation
• Tracheostomy
• upper gastrointestinal endoscopy
• bronchoscopy
• Holding tongue while drenching
• Recumbent position

5. Neuromuscular disease
• multiple sclerosis
• Parkinson’s disease
• myasthenia gravis
• bulbar or pseudo bulbar
palsy
Predisposing Factors

6. Predisposing Factors
Gastro-oesophageal disorders
• incompetent cardiac sphincter
• oesophageal stricture
• neoplasm
• gastric outlet obstruction
• protracted vomiting

7. CLASSIFICATION
Aspiration pneumonia is broadly classified into two
categories
BACTERIAL PNEUMONIA
CHEMICAL PNEUMONITIS

8. BACTERIAL PNEUMONIA
Aspiration of oropharyngeal contents, for example
due to swallowing difficulty, will cause bacterial
pneumonia with mouth organisms predominating.
The micro-organisms that commonly cause these
pneumonias, are Streptococcus pneumoniae,
Haemophilus influenza, Staphylococcus aureus, and
gram-negative bacteria.
They generally are relatively virulent so that only a
small inoculum is required to result in a pneumonia.

9.  INTRODUCTION
 Multiple substances are directly toxic to the
lungs or stimulate an inflammatory
response when aspirated;
 gastric acid is the most common such
aspirated substance
 Aspirated gasoline and kerosene &
petroleum products (particularly of low
viscosity, such as petroleum jelly) can also
cause a chemical pneumonitis.
CHEMICAL PNEUMONITIS

10. CHEMICAL PNEUMONITIS
• Most aspirates in the clinical scenarios are liquid in
nature.
• It is the composition of the aspirate that determines
the extent and progression of the injury on the
pulmonary parenchyma.
• Aspiration of gastric contents will cause a chemical
pneumonitis (e.g. Mendelson’s syndrome) because
the gastric contents are usually sterile, but their
acidity results in the rapid development of
inflammation in the lungs.

11. CHEMICAL PNEUMONITIS
• The equivalent inhaled volume in a 50-kg calf
would be about 15 mL.
• a volume greater than 0.3 mL/kg (B.W.) and
with a pH < 2.5 are required to cause
aspiration pneumonitis (Marik 2001).

12. CHEMICAL PNEUMONITIS
Pathophysiology
The first phase peaks at 1 to2 hours after
aspiration and presumably results from the
direct caustic effect of the low pH on the alveolar-
capillary wall lining cells.
The second phase, which peaks at 4 to 6 hours
is associated with infiltration of neutrophils into
the alveoli and lung interstitium with a histologic
picture of acute inflammation

13. PATHOPHYSIOLOGY OF PNEUMONIA
CAUSED KEROSENE ASPIRATION
Physicochemical Properties of kerosene
Kerosene is a thin, clear liquid formed
from a complex mixture of
hydrocarbons, with density of 0.78–
0.81 g/cm3. It is obtained from the
fractional distillation of petroleum
between 150 and 275°C, resulting in a
mixture of carbon chains that typically
contain between 12 and 15 carbon
atoms per molecule

14. • Low viscosity(60ssu)- deep penetration into
tracheobronchial tree
• High volatility- displaces the alveolar gases & interfere
with ventilation & CNS depression
• Low surface tension- enhance spreading on lung tissue
• <1ml- significant injury
 Physicochemical Properties of kerosene
PATHOPHYSIOLOGY OF PNEUMONIA
CAUSED KEROSENE ASPIRATION

15. PATHOPHYSIOLOGY OF PNEUMONIA
CAUSED KEROSENE ASPIRATION
• Pulmonary pathology -inflammatory cell infiltrates and
morphological changes to tracheal epithelia
• Kerosene can cause significant pulmonary disease by
inducing an inflammatory response, haemorrhagic
exudative alveolitis, and loss of surfactant function.
• decrease in surfactant results in alveolar collapse,
• Secondary effects in the lungs include pneumothorax,
pneumatocele, or bronchopleural fistula.

16. PATHOPHYSIOLOGY OF PNEUMONIA
CAUSED KEROSENE ASPIRATION
• cardiovascular changes -resembling atherosclerosis
• decrease in surfactant results in alveolar collapse,
• ventilation – perfusion mismatch and hypoxemia.
• Hemorrhagic alveolitis can occur which peaks 3
days after ingestion.
• The end result of kerosene aspiration is interstitial
inflammation, intra-alveolar haemorrhage and
edema, hyperaemia, bronchial necrosis, and
vascular necrosis

18. Symptoms & clinical
manifestations
• Abrupt onset of dyspnea
• fever
• Diffuse crackles on exam
• Tachypnea
• Transient cyanosis
• Cough productive of putrid, foul-
tasting/pink frothy sputum
• diffuse crackles
• wheezing

19. Symptoms & clinical
manifestations
Immediate Signs or Symptoms of Acute Exposure of
kerosene aspiration
• Headache
• Drowsiness
• Incoordination
• pneumonitis with choking, & cough
• cyanosis and fever.

20. Treatment
• Mainstay of treatment is SUPPORTIVE
• Avoidance of gastric emptying as it can increases risk of
aspiration
• Ventilator support may be necessary
• Corticosteroids: beneficial in animals
• Antibiotics can be used but supportive & medical care is
essential
• Up to 25% of patients have bacterial superinfection
(Dines et al)

21. Treatment
INDICATIONS FOR ANTIBIOTICS
• Recurrence of fever after first 48 hours
• Leukocytosis after first 48 hours
• Increase infiltrate in chest radiograph
• Sputum or tracheal aspiration positive for bacteria
Infectious Diseases Society of America (IDSA) guidelines
recommend a β-lactam/β-lactamase
inhibitor, clindamycin or amoxicillin

22. Management of aspiration
pneumonia
Supplement oxygen & close monitoring
Selective beta 2 agonist for bronchospasm
Epinephrine avoided- can cause fatal arrhythmias in kerosene
sensitised myocardium
Do not induce vomiting (emesis).
Therapy in cases of uncomplicated chemical pneumonitis
involves
• airway clearance
• correcting the hypoxia by using oxygen supplementation

23. Management of aspiration
pneumonia

24. Management of aspiration
pneumonia
FLUID THERAPY
• Intravenous fluid therapy is indicated as fluid loss is
increased due to panting,tachypnoea & increase in
mucus production
• providing hydration is necessary to liquefy pulmonary
secretions, enabling more rapid clearance of mucus
from the airways
• Avoid giving excess of fluid too, as it can lead to
pulmonary edema.

25. PREVENTION
Strategies to prevent aspiration are important to care
and overall clinical outcome.
For patients with decreased level of consciousness,
avoidance of oral feeding and oral drugs and elevation
of the head of the bed to > 30 degrees may help
drenching of any fluid should never be done while
holding tongue
Proper care taking of sheep while dipping.

26. OUTBREAK NEAR NURPUR
AREA ON 20/3/2015
I along with my batch mate NISHANT THAKUR &
with faculty member
Dr. ANKUR SHARMA from vet. medicine deptt., Dr.
R.K.ASRANI from vet. pathology deptt., Dr. K.B.NAGAL
from vet. Microbiology deptt.
Visited three disease outbreak in sheep & goat flocks
of gaddi’s near nurpur areas(distt. Kangra) on
20/3/2015.

27. PREPARATIONS MADE FOR THE
VISIT
• Following commodities are arranged & packed by us, one
day before leaving for attending the outbreaks.
• 20,21,22 gauze needles & 1 hypodermic needle
• Heparinised, EDTA & new syringes
• Examination gloves & sterile gloves packs
• 1 Microscope, slides & coverslips
• haemoglobinometer
• Spirit swabs & cotton
• Vials, BP blades , scissors
• 2 stethoscopes, & 2 thermometer

28. SHEEP HERD AT REY

29. 1.Outbreak – at Rey
 Owner name – Raju ram
 Total no. of animals- 250 goats & 200 sheep
 Total no. of mortality- 20 adult sheep (all death in last 12 days)
Clinical parameters of some selected animals
animal Rectal temp. (f) Heart rate
(bpm)
Resp.rate/min CMM
4month lamb 105o 150 86 Pale to pink
4year adult
sheep
1040 104 44 Pale to pink
4 year adult
sheep
1060 96 46 Pale to pink

30. OWNER-RAJU RAM WITH HIS HERD

31. 3.Outbreak – at rey
Few sheep revealed dry pulmonary rales
Tentative diagnosis for pneumonia may be caused due
to drenching pneumonia as owner had done drenching
of kerosene oil @2 t.s.f. for 6 days continuously as he
believed it will cure diarrhoea .
Haemoglobin levels ranged between 4-7 g/dl
DLC did not reveal any significant change

32. Blood parameters of
third outbreak
ANIMALS HB(g%) PCV(%) DLC(%)
4month lamb 7 20 L-64, N-36, B-0, E-0
Young sheep 6 21 L-68, N-32, B-0, E-0
Adult sheep 4.2 19 L-78, N-22, B-0, E-0
Adult sheep2 5 19 -------------------------

33. EXAMINATION OF SOME SELECTED ANIMALS

34. Biochemical parameters of
blood of third outbreak
ANIMAL TOTAL
PROTEIN
BILIRUBIN AST ALT
Young sheep 6.1 0.04 440 23
4 month lamb 6.3 0.23 356 40
Adult sheep 8.0 0.02 333 28
Adult sheep 8.0 0.09 252 20

35. LUNG REMOVED WHILE POST-MORTEM OF AN AFFECTED SHEEP
SHOWING ABNORMAL CHANGES IN RIGHT LUNG
EFFECTED LUNG

36. HISTO-PATHOLOGY REPORT OF
LUNG SAMPLE COLLECTED FROM
THIRD OUTBREAK
Hyperplasia & thickening of bronchioles
Alveoli lumen packed with neutrophils
Prominent Blood vessels injury
Interlobular septa distended with exudate
Plasma cells, giant cells infiltration

37. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Zone of neutrophil
infiltrations
Necrosed area

38. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Interlobular
Septa distended
With exudate
Severe haemorrhage

39. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Chronic purulent
Zones having
neutrophil,
Macrophages,
fibroblasts

40. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Plasma cells

41. Alveoli lumen filled with
neutrophil

42. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Hyperplasia
&
thickening
Of
bronchioles

43. Lung tissue showing coagulative
necrosis

44. HISTO-PATHOLOGY REPORT OF LUNG
SAMPLE COLLECTED FROM THIRD
OUTBREAK
Giant cell

45. Treatment advised at
third outbreak
Susp. Nilzan 15ml p.o. & repeat after 3 week – for adult sheep &
goat
Inj. Belamyl 2ml for 3 days i/m –repeat afte break of 3 days
Pwd. Agrimin forte , 2tsf/ adult animal
Inj. Enrofloxacin – to animal with pulmonary affection in
standard doses & schedule
Boli. Ferritas one-fifth of bolus for 5 days – repeat after break of
5 days

46. HENCE IN CONCLUSION THERE IS ONLY
MANAGEMENT ASPECT WHICH WE ADVISED
TO OWNER TO PREVENT ASPIRATION
PNEUMONIA
• We also advised owner to not to give kerosene to
animals.
• Do not drench any fluid while holding tongue.
• Keeping mouth upwards while dipping of sheep.