Observation and patient disposition after essential oil poisoning

For all essential oil poisonings, any patient with a deliberate poisoning or any symptomatic patients should be observed for at least 6 hours and until all symptoms have resolved. Never discharge a child overnight if they have ingested an essential oil due to the risk of aspiration. Advise patients to return if they develop respiratory symptoms.

For eucalyptus oil poisoning:

• observe children in hospital for at least 6 hours if they are symptomatic, or are asymptomatic but have potentially ingested more than 5 mL of eucalyptus oil
• discharge other children if they are asymptomatic, with advice to return if they develop symptoms of aspiration
• observe adults in hospital for at least 6 hours
  • following any deliberate ingestion
  • following ingestion of more than 0.1 mL/kg of eucalyptus oil
  • if they have any symptoms.

For pennyroyal oil or clove oil poisoning:

• if acetylcysteine is indicated (see Acetylcysteine for hepatoprotection), admit patients to hospital and assess liver biochemistry on admission and 24 hours after ingestion for evidence of hepatotoxicity
• if acetylcysteine is not indicated, observe patients for at least 6 hours after ingestion for the development of symptoms; however, accidental ingestions in children involving a lick or a taste have a low risk of harm and asymptomatic children may not require observation in hospital. On discharge, advise patients to return if they develop symptoms of aspiration or gastrointestinal symptoms.

Sedative agents can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after discharge.