a) Complex mixture; petroleum or shale oil wide-cut naphtha type hydrocarbons, mainly in the C-4 to C-16 range (Stallard & Krautter, 1984; CONCAWE, 1985). Actual composition may vary with required performance specifications (CRC & Inc, 1984).
b) Typical composition of JP-4 is shown in the following table (US Air Force, 1989; IARC, 1989):
c) Hydrocarbons (C-4 to C-16), consisting of:
d) COMPOSITION OF JP-5
e) COMPOSITION OF JP-7
f) COMPOSITION OF JP-8

a) Transfer operations to storage tanks, tanker trucks or railroad cars, or fueling of aircraft (IARC, 1989);
b) Inside buildings where aircraft maintenance operations are taking place (US Air Force, 1981);
c) Operations involving refining, blending, or final formulation of the fuels with additives;
d) Filling, draining, and maintenance of fuel tanks, maintenance of distribution tanks and pipelines, engine maintenance, and laboratory sampling and analysis (Lombardi & Lurie, 1957; IARC, 1989; Pleil et al, 2000);
e) Manufacture and/or testing of jet aircraft engines (Struwe et al, 1983; IARC, 1989);
f) Jet aircraft pilots.
g) NIOSH has estimated that 9,730 employees were occupationally exposed to JP-4 between 1980 and 1983 (NIOSH, 1990).

a) Evaporation or leakage from fuel storage tanks; aircraft fueling operations; in industrial waste streams; or in pipeline, trucking, or railroad leaks or accidents;
b) Jettison maneuvers from aircraft, or spills on the ground or into surface water in aircraft crashes (IARC, 1989);
c) Household activities such as bathing, laundering, and cooking with contaminated water, or other activities using contaminated hot water.

1) Acute exposure to jet fuel can cause CNS depression, headache, dizziness, anxiety, respiratory irritation, and palpitations. Inhalation of liquid hydrocarbons may also induce euphoria, cardiac dysrhythmias, and respiratory arrest. Ingestion may cause potentially fatal aspiration pneumonitis. Human exposure primarily occurs as a result of inhalation or dermal contact.

1) Jet fuel is slightly irritating to the eyes and nose. Ear loss has been associated with persistent jet fuel exposure.

1) Palpitations have been reported from exposure to jet fuel. Dysrhythmias may occur following inhalation of some hydrocarbons.

1) Jet fuel vapors are irritating to the respiratory tract.
2) Ingestion with subsequent pulmonary aspiration may produce pulmonary edema and possibly fatal chemical pneumonitis; this is one of the most serious hazards.
3) Coughing, choking, tachypnea, dyspnea, cyanosis, rales, hemoptysis, and pulmonary edema may occur following ingestion with pulmonary aspiration of liquid hydrocarbons.

1) Transient CNS excitation followed by depression may occur, especially after inhalation of liquid hydrocarbons.
2) Peripheral sensory neuropathies and motor deficits have been reported from exposure to jet fuel.
3) Neuropsychiatric abnormalities have been seen. These may include anxiety, memory loss, and irritability.

1) Liquid Jet fuel is irritating to the stomach.

1) Liver injury, as manifested by elevated transaminases, may occur following ingestion of liquid hydrocarbons.
2) Antipyrene clearance has been altered in humans exposed to jet fuel, but clinical liver function was not altered. Experimental animal studies have shown degenerative fatty changes in the liver.

1) Acute renal tubular necrosis, proteinuria, or hematuria occur infrequently following acute hydrocarbon exposure.
2) Renal effects seen in male rats exposed to jet fuel may not be relevant to humans.

1) Hemolysis may occur with aspiration pneumonitis. Hematologic depression has been seen in experimental animals, but not in humans.

1) Jet fuel is a strong skin irritant and can cause a defatting dermatitis.
2) Shale-derived jet fuels were dermal sensitizers in guinea pigs. Jet fuels can induce inflammatory responses from dermal application to experimental animals.

1) Increased antipyrene clearance has been seen in humans.

1) Neuropsychiatric disorders including anxiety and depression, fatigue, personality changes, neurasthenic syndrome, memory deficits, mood changes, attention deficits, psychosomatic symptoms, attention deficits, sleep disturbances, anxiety, irritability, and impairment of memory have been reported.

1) One case of Goodpasture's syndrome has been reported.

1) ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.

1) Consider phenobarbital or propofol if seizures recur after diazepam 30 mg (adults) or 10 mg (children greater than 5 years).
2) Monitor for hypotension, dysrhythmias, respiratory depression, and need for endotracheal intubation. Evaluate for hypoglycemia, electrolyte disturbances, and hypoxia.

1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

a) Effects secondary to aspiration may include hypoxia, infection, pneumatocele formation, and chronic lung dysfunction.
b) Chronic exposure has been linked with neuropsychiatric disorders.
c) Chronic exposure to jet fuels has been linked with kidney cancer in humans in one study. Jet fuel is not classified as a confirmed human carcinogen. Potential human reproductive hazards, if any, have not yet been defined.
d) Similar effects have been seen with petroleum- and shale oil-derived jet fuel in experimental animals.
e) This review is based on information from JP-4, JP-5, JP-7, JP-8, unspecified jet fuel, and liquid hydrocarbons such as kerosene.

1) Jet fuel is slightly irritating to the eyes and nose. Ear loss has been associated with persistent jet fuel exposure.

1) Neither JP-4 nor JP-7 was irritating to the eye in rabbits (US Air Force, 1984)(Clark, 1989) (EPA, 1982a).

1) CHRONIC EXPOSURE - In a case-control study of current noised-exposed workers with and without jet fuel (JP-4) exposure at a military instillation, workers with 3 years of exposure had a 70% increase in adjusted odds of hearing loss (OR = 1.7; 95% CI = 1.14-2.53). Odds increased to 2.41 (95% CI = 1.04-5.57) for 12 years of noise and jet fuel exposure. The duration of exposure was associated with an increased risk of persistent hearing loss even though exposure was below normal limits for organic solvents. Overall, fuel oil exposure was less than 34% of the OSHA Threshold Limit Values (TLV). In the persistent hearing loss model, regular consumption of alcohol was the most significant factor, with a 3-fold increase in risk (OR = 3.03; 95% CI = 1.42-6.45); jet fuel exposure was also significant (OR = 1.23; 95% CI = 1.05-1.44) (Kaufman et al, 2005).

1) JP-4 vapor is slightly irritating to the nose (CHRIS , 1993).

1) Palpitations have been reported from exposure to jet fuel. Dysrhythmias may occur following inhalation of some hydrocarbons.

1) WITH POISONING/EXPOSURE

1) WITH POISONING/EXPOSURE

1) Jet fuel vapors are irritating to the respiratory tract.
2) Ingestion with subsequent pulmonary aspiration may produce pulmonary edema and possibly fatal chemical pneumonitis; this is one of the most serious hazards.
3) Coughing, choking, tachypnea, dyspnea, cyanosis, rales, hemoptysis, and pulmonary edema may occur following ingestion with pulmonary aspiration of liquid hydrocarbons.

1) WITH POISONING/EXPOSURE

1) CHANGES IN PULMONARY FUNCTION - Increases in dynamic compliance, pulmonary resistance, and alveolar clearance of [Tc-99m]-diethylenetriamine pentaacetate, and decreased concentrations of substance P in bronchoalveolar lavage fluid, were seen in Fischer 344 rats exposed to JP-8 jet fuel by inhalation under conditions simulating military flightline exposure (Pfaff et al, 1995).
2) Significant (p < 0.05) cytosolic and whole lung protein expression alterations were seen in a study of 30 male Swiss-Webster mice (n = 15 exposure; n = 15 controls) exposed to aerosolized JP-8 vapors. Total exposure time was 1 hour per day for 7 days, an equivalent of 250, 1000 and 2300 mg/m(3). At the highest level, a total of 165 proteins were altered in the lung cytol tissue. Seven proteins were identified and found to be significant markers of JP-8-induced stress on lung epithelial cells. One protein, alpha1-anti-trypsin (AAT), has potential implications for the development of chronic obstructive pulmonary disorder (COPD) and pulmonary emphysema (Drake et al, 2003).

1) Transient CNS excitation followed by depression may occur, especially after inhalation of liquid hydrocarbons.
2) Peripheral sensory neuropathies and motor deficits have been reported from exposure to jet fuel.
3) Neuropsychiatric abnormalities have been seen. These may include anxiety, memory loss, and irritability.

1) WITH POISONING/EXPOSURE

1) WITH POISONING/EXPOSURE

1) SEIZURES

1) Liquid Jet fuel is irritating to the stomach.

1) WITH POISONING/EXPOSURE

1) Liver injury, as manifested by elevated transaminases, may occur following ingestion of liquid hydrocarbons.
2) Antipyrene clearance has been altered in humans exposed to jet fuel, but clinical liver function was not altered. Experimental animal studies have shown degenerative fatty changes in the liver.

1) WITH POISONING/EXPOSURE

1) LIVER FATTY

1) Acute renal tubular necrosis, proteinuria, or hematuria occur infrequently following acute hydrocarbon exposure.
2) Renal effects seen in male rats exposed to jet fuel may not be relevant to humans.

1) WITH POISONING/EXPOSURE

1) TOXIC NEPHROPATHY

1) Hemolysis may occur with aspiration pneumonitis. Hematologic depression has been seen in experimental animals, but not in humans.

1) WITH POISONING/EXPOSURE

1) WITH POISONING/EXPOSURE

1) BLOOD DYSCRASIA

1) Jet fuel is a strong skin irritant and can cause a defatting dermatitis.
2) Shale-derived jet fuels were dermal sensitizers in guinea pigs. Jet fuels can induce inflammatory responses from dermal application to experimental animals.

1) WITH POISONING/EXPOSURE

1) WITH POISONING/EXPOSURE

1) IRRITATION

1) One case of Goodpasture's syndrome has been reported.

1) WITH POISONING/EXPOSURE

1) HUMANS - No reproductive studies were found for military jet fuel in either humans or animals.
2) Some of the components of jet fuel, such as BENZENE and TOLUENE, are suspect human reproductive hazards.
3) HYDROCARBONS/GENERAL - Paternal exposure to hydrocarbons has been suggested as a causative factor in Prader-Willi syndrome (Strakowski & Butler, 1987). Approximately half of patients' fathers had occupational exposure to hydrocarbons at or around the time of conception in one study (Cassidy et al, 1989).
4) Refer to individual TOMES(R) MEDITEXT(TM) Medical Managements on these substances for more information.

1) EXPERIMENTAL ANIMAL DATA - Jet fuel A, a related commercial jet fuel, did not cause birth defects in rats (Beliles & Mecler, 1982; Schreiner, 1983). Jet fuel was not embryotoxic or teratogenic in rats exposed to 100 or 400 ppm (Beliles & Mecler, 1983).

1) An association between SPONTANEOUS ABORTION and exposure to aliphatic hydrocarbons during pregnancy has been reported (Lindbohm et al, 1990).

1) No information was found on the possible effects of exposure to jet fuel during lactation or breast feeding.

1) HUMANS - No studies were found on the possible carcinogenic activity of JP-4 or JP-7 in humans.
2) IARC/INADEQUATE EVIDENCE - IARC has concluded that there is inadequate evidence for assessing the carcinogenicity of jet fuel in humans or animals (IARC, 1989).

1) An association between exposure to unspecified jet fuel and kidney cancer was reported in male cancer patients in Montreal, Canada (Odds Ratio = 2.5, statistically significant) (Siemiatycki et al, 1987).

1) COLORECTAL CANCER - A weaker association with colorectal cancers has also been reported for jet fuel (Siemiatycki et al, 1987) Milham, 1976) .

1) JP-7 was NOT carcinogenic in chronic inhalation studies (US Air Force, 1991).
2) JP-4 induced alveolar/bronchiolar tumors in female rats (Bruner et al, 1991), and pulmonary adenomas and lymphosarcomas in mice (Kinkead et al, 1974).
3) Hepatocellular tumors were seen in female mice, and renal tumors in male rats. The renal tumors were similar to those seen in male rats exposed to other petroleum products (Bruner et al, 1991).
4) Unspecified jet fuel was not carcinogenic in a mouse skin painting study (Freeman et al, 1990).
5) Both shale- and petroleum-derived JP-4 increased skin tumors in mice exposed for up to 105 weeks (Clark et al, 1988).

1) LACK OF HUMAN CARCINOGENICITY - Jet fuel is not considered a human carcinogen at this time. Further epidemiological studies would need to be done before jet fuel could be considered to cause cancer in humans.

1) Standard clinical laboratory tests have usually been normal in all but the most severe exposures.

1) Obtain arterial blood gases in symptomatic patients with possible pulmonary aspiration.

1) Monitor CBC, including peripheral smear, in patients with aspiration pneumonitis or CNS symptoms.

1) Monitor liver and kidney function in patients with CNS symptoms.
2) Renal function tests including BUN and creatinine.

1) Urinalysis for protein, albumin, and casts should be obtained and monitored in patients with CNS symptoms.

1) ELECTROPHYSIOLOGICAL TESTING
2) NEUROPSYCHOLOGICAL TESTING
3) PULMONARY FUNCTION TESTS

a) NMR SPECTROSCOPY has been used to analyze gastric contents for kerosene, which is closely related to jet fuel (Yamaguchi et al, 1992).
b) GAS CHROMATOGRAPHY - MASS SPECTROMETRY: A non-invasive tape-strip technique coupled with gas chromatography - mass spectrometry analysis has been used experimentally to detect exposure to JP-8. Napthalene was used as a marker of dermal exposure (Chao et al, 2006).

A) If a patient is symptomatic, admission is indicated.

A) Accidental ingestions of small quantities of hydrocarbons can safely be monitored at home, provided that the patient is asymptomatic, there is access to a follow-up mechanism, and no suspicious indications of child abuse or attempted suicide exist (Machado et al, 1988).

1) Gastric decontamination may be indicated in cases of ingestion of very large amounts of jet fuel, because of the possible presence of additives with potential for systemic toxicity.
2) Consider aspiration of gastric contents using a small nasogastric tube after large ingestions. The risk of aspiration pneumonitis must be weighed against the potential benefits.
3) Activated charcoal adsorbs the related substances kerosene, turpentine, and benzene, and may be indicated in patients who have ingested large amounts of jet fuel.
4) In a series of 255 patients ingesting hydrocarbons (35 to 37% ingested turpentine) pulmonary complications were less frequent in those given syrup of ipecac than in those receiving gastric lavage without a cuffed endotracheal tube. Pneumonitis occurred in 28% treated with ipecac and 56% treated with lavage (Ng et al, 1974).

1) Activated charcoal adsorbs kerosene, turpentine, and benzene in vitro and in animal models (Chin et al, 1969; Laass, 1974; Laass, 1980) Raush, 1935; (Decker et al, 1981). Its efficacy for other hydrocarbons is not documented.
2) CHARCOAL ADMINISTRATION
3) CHARCOAL DOSE

1) If the patient is symptomatic upon arrival at the medical facility, pulmonary aspiration may have already occurred. Monitor arterial blood gases in cases of severe aspiration pneumonitis to ensure adequate ventilation. Administer supplemental oxygen as indicated.

1) CHEST X-RAY - Obtain a baseline chest X-ray in all patients with respiratory symptoms.

1) SUMMARY
2) DIAZEPAM
3) NO INTRAVENOUS ACCESS
4) LORAZEPAM
5) PHENOBARBITAL
6) OTHER AGENTS

1) ONSET: Onset of acute lung injury after toxic exposure may be delayed up to 24 to 72 hours after exposure in some cases.
2) NON-PHARMACOLOGIC TREATMENT: The treatment of acute lung injury is primarily supportive (Cataletto, 2012). Maintain adequate ventilation and oxygenation with frequent monitoring of arterial blood gases and/or pulse oximetry. If a high FIO2 is required to maintain adequate oxygenation, mechanical ventilation and positive-end-expiratory pressure (PEEP) may be required; ventilation with small tidal volumes (6 mL/kg) is preferred if ARDS develops (Haas, 2011; Stolbach & Hoffman, 2011).
3) FLUIDS: Crystalloid solutions must be administered judiciously. Pulmonary artery monitoring may help. In general the pulmonary artery wedge pressure should be kept relatively low while still maintaining adequate cardiac output, blood pressure and urine output (Stolbach & Hoffman, 2011).
4) ANTIBIOTICS: Indicated only when there is evidence of infection (Artigas et al, 1998).
5) EXPERIMENTAL THERAPY: Partial liquid ventilation has shown promise in preliminary studies (Kollef & Schuster, 1995).
6) CALFACTANT: In a multicenter, randomized, blinded trial, endotracheal instillation of 2 doses of 80 mL/m(2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality; however, no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was noted. Adverse effects (transient hypoxia and hypotension) were more frequent in calfactant patients, but these effects were mild and did not require withdrawal from the study (Wilson et al, 2005).
7) However, in a multicenter, randomized, controlled, and masked trial, endotracheal instillation of up to 3 doses of calfactant (30 mg) in adults only with acute lung injury/ARDS due to direct lung injury was not associated with improved oxygenation and longer term benefits compared to the placebo group. It was also associated with significant increases in hypoxia and hypotension (Willson et al, 2015).

1) Catecholamines should be used with caution due to a possible decreased myocardial threshold for development of arrhythmias.

1) Have not been shown to be of benefit in treating hydrocarbon pneumonitis.

1) Parenteral Exposure - Close medical follow-up for potential pneumonitis or local reaction is imperative. Aggressive management of local abscess with incision and drainage, as well as appropriate antibiotic usage, is indicated.

1) Extracorporeal membrane oxygenation (ECMO) has been reported to be successful in pediatric aspiration involving hydrocarbons.

1) Remove all contaminated clothing as soon as possible, without endangerment of medical personnel.

1) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

1) Dermal irritation should be treated with standard therapy, including cortisone creams for persistent redness or swelling. Lubricating creams may be helpful for replacing skin oils lost to defatting action.

1) The patient should be observed under controlled conditions for 4 to 6 hours for possible development of systemic effects.

a) Other symptoms self-reported in this group included palpitations, a feeling of pressure in the chest, and respiratory irritation (Struwe et al, 1983).

1) 25 g/kg