Lipoid pneumonia

Lubricant laxatives work by coating the stool, which allows it to be expelled more easily. The oily film covering the stool also keeps the stool from losing its water to intestinal reabsorption processes. Mineral oil (liquid petrolatum) is a non-prescription heavy oil that should be used with caution, if at all, since it may be aspirated into the lungs and cause lipoid pneumonia. This is of particular concern in the young or the elderly. 

Mineral Oil Hydraulic Fluids. Lipoid pneumonia with marked interstitial pneumonitis and pulmonary fibrosis was observed in a child accidentally ingesting a lethal dose of automotive transmission fluid (Perrot and Palmer 1992). Although the exact composition of the hydraulic fluid was not reported, it is assumed to be a mineral oil hydraulic fluid because automotive transmission fluids typically contain... 

Oil accumulation in the lungs after long-term or high-level exposure to aerosols of polyalphaolefin may be a concern, based on observations of lipoid pneumonia in humans after prolonged intranasal application of mineral oil mists (Lushbaugh 1950) and the physical and chemical similarities between mineral oil and polyalphaolefins (i.e., both are composed predominately of aliphatic hydrocarbons). 

Based on physical and chemical similarities between mineral oil and polyalphaolefins, oil accumulation in the lung (and subsequent lipoid pneumonia) may occur following the ingestion of polyalphaolefin hydraulic fluids due to aspiration, and that distribution of polyalphaolefins to the liver and fatty tissues may occur to some degree (see discussion for distribution of mineral oil hydraulic fluids). 

Mineral Oil Hydraulic Fluids. Only one report was located regarding death in humans following exposure to mineral oil hydraulic fluids. A 14-month-old boy ingested 5-10 cc of a mineral oil hydraulic fluid and died 4 weeks later after developing pneumonia (Perrot and Palmer 1992). Postmortem analysis revealed edema, hemorrhages, and lipoid/oil droplets in the lungs. The attending physicians believed that the development of lipoid pneumonia with marked interstitial pneumonitis eventually led to death. 

Mineral Oil Hydraulic Fluids. There is a paucity of data on respiratory effects following inhalation, oral, or dermal exposure to mineral oil hydraulic fluids. The only available information for humans comes from a case report of a child ingesting a lethal dose of an automotive transmission fluid, which was most likely a mineral oil hydraulic fluid. Lipoid pneumonia with marked fibrosis was observed (Perrot and Palmer... 

Perrot LJ, Palmer H. 1992. Fatal hydrocarbon lipoid pneumonia and pneumonitis secondary to automatic transmission fluid ingestion. J Forensic Sci 37 1422-1427. 

Mineral oil may be absorbed systemically and cause a foreign-body reaction in lymphoid tissue. Also, in debilitated or recumbent patients, mineral oil may be aspirated, causing lipoid pneumonia. 

Solubility/miscibility Insoluble in water and ethanol. Soluble in ether and oils Biological considerations Aspiration may cause lipoid pneumonia Chemical compatibility/Stability considerations Flammable Uses (routes) Oral, vaginal, rectal, dermal. Suspending agent... 

Numerous case studies have described death following the accidental ingestion of kerosene by children (usually under the age of 5 but as old 15 years). The deaths are usually attributed to lipoidal pneumonia (Morrison and Sprague 1976 Santhanakrishnan and Chithra 1978 Zucker et al. 1986) that was probably induced by the aspiration of the kerosene. Specific respiratory effects associated with death from kerosene ingestion include pneumothorax (Mahdi 1988 Zucker et al. 1986), emphysema (Mahdi 1988), and pneumonitis (Singh et al. 1981). Cardiac arrhythmia was reported as the cause of death in one child however, it was suspected that myocarditis and pulmonary edema may have been the cause of the rapid deterioration and death of the child (Dudin et al. 1991). 

Lubricant laxatives. Liquid paraffin (paraffinum subliquidum) is almost nonabsorbable and makes feces softer and more easily passed. It interferes with the absorption of fat-soluble vitamins by trapping them. The few absorbed paraffin particles may induce formation of foreign-body granulomas in enteric lymph nodes (paraffinomas). Aspiration into the bronchial tract can result in lipoid pneumonia. Because of these adverse effects, its use is not advisable. 

Liquid paraffin can cause a lipoid pneumonia or pneumonitis if inhaled (11). This has been treated with bronch-oalveolar lavage (12). Lipoid pneumonia in a 34-year-old fire-eater who inhaled liquid paraffin was treated with prednisolone, antibiotics, and urinastatin (13). 

An 82-year-old woman who had taken long-term liquid paraffin as a laxative, developed a lipoid pneumonia and a mesothelioma (113). 

Ohwada A, Yoshioka Y, Shimanuki Y, Mitani K, Kumasaka T, Dambara T, Fukuchi Y. Exogenous lipoid pneumonia following ingestion of liquid paraffin. Intern Med 2002 41(6) 483-6. 

Yokohori N, Taira M, Kameyama S, Kanemura T, Rondo M, Tamaoki I, Nagai A. [Acute form of exogenous lipoid pneumonia caused by inhalation of liquid paraffin in a fire-eater.] Nihon Kokyuki Gakkai Zasshi 2002 40(7) 588-93. 

Borrie J, Gwynne JF. Paraffinoma of lung lipoid pneumonia. Report of two cases. Thorax 1973 28(2) 214-21. 

The most serious adverse reaction to mineral oil is lipoid pneumonia caused by aspiration of the oil. Mineral oil can enter the bronchial tree without eliciting the cough reflex.With the reduction in the use of mineral oil in nasal formulations, the incidence of lipoid pneumonia has been greatly reduced. However, lipoid pneumonia has also been associated with the use of mineral oil-containing cosmetics and ophthalmic preparations. It is recommended that products containing mineral oil not be used in very young children, the elderly, or persons with debilitating illnesses. 

Becton DL, Lowe JE, Falleta JM. Lipoid pneumonia in an adolescent girl secondary to use of lip gloss. J Pediatr 1984 105 421M23. 

Petrolatum has also been tentatively implicated in the formation of spherulosis of the upper respiratory tract following use of a petrolatum-based ointment packing after surgery, and lipoid pneumonia following excessive use in the perinasal area. Other adverse reactions to petrolatum include granulomas (paraffinomas) following injection into soft tissue. Also, when taken orally, petrolatum acts as a mild laxative and may inhibit the absorption of lipids and lipid-soluble nutrients. 

Cohen MA, Galbut B, Kerdel FA. Exogenous lipoid pneumonia caused by facial application of petrolatum. JAMA 2003 49 1128-1130. 

It may enter the lung through aspiration and cause lipoid pneumonia. 

Smoking Sarcoidosis Tuberculosis Lipoid pneumonia Systemic lupus erythematosus Rheumatoid arthritis Systemic sclerosis Polymyositis/dermatomyositis Sjogren s syndrome Polyarteritis nodosa Wegener s granuloma Byssinosis (cotton workers)... 

Moreover, safety issues are of concern also for the type of oil that can be used. Most commonly used oil for Oi/On emulsions is paraffln/mineral oils that is known to cause severe lipoid pneumonia,and therefore must be excluded from injectible formulations. Arachis oil (peanut oil) is vegitable oil, which has been suggested by different pharmacopoeia as standard oil for injections. However, purified arachis oil may contain peanut proteins that are allergenic. In rare cases, anaphylactic reaction and hypotension may occur after parenteral administration of arachis oil however, severe reactions may occur in persons with allergy to this oil. Since the European... 

Perings SM, Hennersdorf M, Koch J-A, Perings C, Kelm M, Heintzen MP et al. Lipoid pneumonia following attempted suicide by intravenous injection of lamp oil. Med Klin. 2001 96 685-688. 

Simmons A, Rouf E, Whittle J. Not your typical pneumonia A case of exogenous lipoid pneumonia. Journal of General Internal Medicine. November 2007 22(11) 1613-1616. PubMed PMID 17846847. Pubmed Central PMCID 2219803. 

Lipoid pneumonia Mineral oil [33] Gas chromatography/mass spectrometry... 

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