Intravenous xylene poisoning

Course of matrix metalloproteinase-1 and pulmonary oxygenation in acute respiratory distress syndrome caused by oral ingestion of large doses of oxadiazon/butachlor emulsion: a case report

Background

We treated a patient who developed acute respiratory distress syndrome following ingestion of oxadiazon/butachlor emulsion. In this case, we continuously measured matrix metalloproteinase-1 level, an enzyme that reduces the extracellular matrix in the lungs, and tissue inhibitors of metalloproteinase-1.

Case Presentation

A 50-year-old woman attempted suicide by ingesting approximately 300 mL of oxadiazon/butachlor emulsion. Respiratory disorders were observed upon admission, therefore tracheal intubation was performed, followed by artificial respiratory management (ventilator support). After that, her condition became complicated by acute respiratory distress syndrome, but it improved with intensive care management. Matrix metalloproteinase-1 level showed a course opposite to the partial pressure of arterial oxygen/percentage of inspired oxygen ratio, whereas the matrix metalloproteinase-1/tissue inhibitors of metalloproteinase-1 ratio changed in parallel with the partial pressure of arterial oxygen/percentage of inspired oxygen ratio.

Conclusion

The relationship between matrix metalloproteinase-1 and tissue inhibitors of metalloproteinase-1 was presumed to be important for the development of acute respiratory distress syndrome.

Acute amitraz intoxication: retrospective analysis of 45 cases

Objective: To present special clinical and laboratory features of 45 cases (44 adult cases) who were intoxicated through oral route. Design: Retrospective study. Setting: Intensive care unit (ICU) of a university hospital. Patients: Forty-five patients admitted to the ICU of Cumhuriyet University Hospital. Results: Forty-five patients between 4 and 97 years of age were evaluated. Intoxication was the result of a suicide attempt in 67% of cases and accidental in 33% of cases. Unconsciousness, nausea and vomiting were the common initial symptoms. The major clinical findings in the ICU were bradycardia, myosis, hypothermia, hyperglycemia, hypotension, coma and respiratory depression. Blood glucose level was increased in 64% of cases. No problem was noted in the patient or the fetus in a pregnant, 27-year-old patient, who was intoxicated with 10 mL of 12.5% amitraz. The length of stay in the ICU was between 2 and 15 days. None of the patients died. All patients were discharged without neurological sequela. Conclusion: The prognosis of amitraz intoxications through oral route is benign and results in complete healing; however, we suggest that these cases should be well monitored and followed-up in ICUs.

Health hazards of xylene: a literature review

Xylene, an aromatic hydrocarbon is widely used in industry and medical laboratory as a solvent. It is a flammable liquid that requires utmost care during its usage. On exposure the vapours are rapidly absorbed through the lungs and the slowly through the skin. Prolonged exposure to xylene leads to significant amount of solvent accumulation in the adipose and muscle tissue. This article reviews the various acute and chronic health effects of xylene through various routes of exposure.

ATSDR evaluation of health effects of chemicals. V. Xylenes: health effects, toxicokinetics, human exposure, and environmental fate

Xylenes, or dimethylbenzenes, are among the highest-volume chemicals in production. Common uses are for gasoline blending, as a solvent or component in a wide variety of products from paints to printing ink, and in the production of phthalates and polyester. They are often encountered as a mixture of the three dimethyl isomers, together with ethylbenzene. As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals found at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) sites that are of greatest concern for public health purposes. These profiles comprehensively summarize toxicological and environmental information. This article constitutes the release of the bulk of this profile (ATSDR, 1995) into the mainstream scientific literature. An extensive listing of known human and animal health effects, organized by route, duration, and end point, is presented. Toxicological information on toxicokinetics, biomarkers, interactions, sensitive subpopulations, reducing toxicity after exposure, and relevance to public health is also included. Environmental information encompasses physical properties, production and use, environmental fate, levels seen in the environment, analytical methods, and a listing of regulations. ATSDR, as mandated by CERCLA (or Superfund), prepares these profiles to inform and assist the public.

Intravenous thiodan (30% endosulfan in xylene)

OBJECTIVE

We report the first case of intravenous self-poisoning with Thiodan (30% endosulfan in xylene).

CASE REPORT

A 28-year-old woman with a past history of epilepsy presented with refractory grand mal seizures after injecting 1 mL of Thiodan intravenously. She developed liver dysfunction, proximal myopathy secondary to rhabdomyolysis and renal failure.

INTERVENTIONS AND OUTCOMES

The seizures were terminated with midazolam and thiopentone. Mechanical ventilation was required for nine days. Renal and liver dysfunction resolved with supportive measures only. Hemodialysis was not required. Pulmonary complications and neurological sequelae were minimal with the patient making a full recovery over three months.

CONCLUSION

The intravenous adminis-tration of a small dose of endosulfan in xylene caused the rapid onset of severe grand mal seizures. The absence of pulmonary edema in this case suggests aspiration to be the cause of pulmonary toxicity due to oral endosulfan poisoning.