Diagnostic radiopacity and hepatotoxicity following chloroform ingestion: a case report

Halogen-sensitive solvatochromism based on a phenolic polymer of tetraphenylethene

Herein, we describe the successful preparation of a methylene-bonded tetraphenylethene polymer using a phenolic-resin synthesis protocol. Our novel phenolic polymer showed solvatochromism in response to halogenated organic solvents. Solvatochromism is induced by halogen/π interactions between the polymer and the organic halide.

Herein, we describe novel phenolic polymer showed solvatochromism in response to halogenated organic solvents through halogen/π interactions.

Chronic, Recreational Chloroform-Induced Liver Injury

Historically used as an anesthetic, chloroform is a halogenated hydrocarbon that is associated with central nervous system depression, arrhythmias, and hepatotoxicity. It is no longer used clinically, but accidental and intentional poisonings still occur. We report a case of chronic chloroform abuse leading to severe hepatotoxicity in a 26-year-old male graduate student. The patient presented to the emergency department with a three-day history of abdominal pain, dehydration, and scleral icterus. He drank several beers the night before the onset of symptoms, but denied taking acetaminophen, ibuprofen, or other drugs. An extensive work-up revealed an aspartate aminotransferase (AST) of 13,527 U/L and alanine aminotransferase (ALT) of 8,745 U/L, but the cause of his liver injury could not be determined. It was not until many months later that the patient admitted to inhaling chloroform in the weeks leading up to his illness.

Systemic inflammatory response due to chloroform intoxication--an uncommon complication

Well-known adverse effects of chloroform are drowsiness, nausea, and liver damage. Two cases with an uncommon complication due to chloroform intoxication are presented. In the first case, a general physician, because of nausea and dyspnea, admitted a 34-year-old woman to hospital. She developed a toxic pulmonary edema requiring mechanical ventilation for a few days, and a systemic inflammatory response syndrome (SIRS) with elevated white blood cell counts, a moderate increase of C-reactive protein, and slightly elevated procalcitonin levels. There were inflammatory altered skin areas progressing to necrosis later on. However, bacteria could be detected neither in blood culture nor in urine. Traces of chloroform were determined from a blood sample, which was taken 8 h after admission. Later, the husband confessed to the police having injected her chloroform and put a kerchief soaked with chloroform over her nose and mouth. In the second case, a 50-year-old man ingested chloroform in a suicidal attempt. He was found unconscious in his house and referred to a hospital. In the following days, he developed SIRS without growth of bacteria in multiple blood cultures. He died several days after admission due to multi-organ failure. SIRS in response to chloroform is a rare but severe complication clinically mimicking bacterial-induced sepsis. The mechanisms leading to systemic inflammation after chloroform intoxication are currently unclear. Possibly, chloroform and/or its derivates may interact with pattern recognition receptors and activate the same pro-inflammatory mediators (cytokines, interleukins, prostaglandins, leukotrienes) that cause SIRS in bacterial sepsis.

Toxicant-associated steatohepatitis

Hepatotoxicity is the most common organ injury due to occupational and environmental exposures to industrial chemicals. A wide range of liver pathologies ranging from necrosis to cancer have been observed following chemical exposures both in humans and in animal models. Toxicant-associated fatty liver disease (TAFLD) is a recently named form of liver injury pathologically similar to alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD). Toxicant-associated steatohepatitis (TASH) is a more severe form of TAFLD characterized by hepatic steatosis, inflammatory infiltrate, and in some cases, fibrosis. While subjects with TASH have exposures to industrial chemicals, such as vinyl chloride, they do not have traditional risk factors for fatty liver such as significant alcohol consumption or obesity. Conventional biomarkers of hepatotoxicity including serum alanine aminotransferase activity may be normal in TASH, making screening problematic. This article examines selected chemical exposures associated with TAFLD in human subjects or animal models and concisely reviews the closely related NAFLD and ALD.

Two fatalities associated with chloroform inhalation. Variation of toxicological and pathological findings

We report a forced double suicide involving a wife and husband in their late 80s resulting from chloroform inhalation. Macro- and microscopic examinations revealed marked pulmonary edema and extensive contraction band necrosis of the cardiac muscles. Toxicological analysis revealed high levels of chloroform in the blood (41.4 μg/ml in the wife and 29.1 μg/ml in the husband) and in the adipose tissue (128 μg/g in the wife and 131 μg/g in the husband). From these findings, we conclude that the cause of death of both was acute heart failure due to chloroform poisoning. In addition, the pathological examination of the husband revealed submucosal hemorrhage at the root of the tongue and trachea, erosion of the stomach, and upper jejunum, none of which were present in the wife. Furthermore, hyperemia of the mucous membrane of the husband was more marked than that of the wife. Toxicological analysis also revealed that the chloroform levels in the liver and brain of the husband were higher than those of the wife, although the chloroform level in the blood of the husband was lower than that of the wife. We presume that the wife may have inhaled a greater amount of chloroform, and that the wife's circulation may have arrested before irritation of the mucous membranes became apparent. The husband may have inhaled a smaller amount of chloroform in longer duration, leading to irritation of the mucous membranes prior to the fatal heart failure. These findings suggest that toxicological and pathological outcomes of chloroform poisoning may vary between patients, and that they may reflect the dose and duration of chloroform inhalation.

Acute chloroform ingestion successfully treated with intravenously administered N-acetylcysteine

Chloroform, a halogenated hydrocarbon, causes central nervous system depression, cardiac arrhythmias, and hepatotoxicity. We describe a case of chloroform ingestion with a confirmatory serum level and resultant hepatotoxicity successfully treated with intravenously administered N-acetylcysteine (NAC). A 19-year-old man attempting suicide ingested approximately 75 mL of chloroform. He was unresponsive and intubated upon arrival. Intravenously administered NAC was started after initial stabilization was complete. His vital signs were normal. Admission laboratory values revealed normal serum electrolytes, AST, ALT, PT, BUN, creatinine, and bilirubin. Serum ethanol level was 15 mg/dL, and aspirin and acetaminophen were undetectable. The patient was extubated but developed liver function abnormalities with a peak AST of 224 IU/L, ALT of 583 IU/L, and bilirubin level reaching 16.3 mg/dL. NAC was continued through hospital day 6. Serum chloroform level obtained on admission was 91 μg/mL. The patient was discharged to psychiatry without known sequelae and normal liver function tests. The average serum chloroform level in fatal cases of inhalational chloroform poisoning was 64 μg/mL, significantly lower than our patient. The toxicity is believed to be similar in both inhalation and ingestion routes of exposure, with mortality predominantly resulting from anoxia secondary to central nervous system depression. Hepatocellular toxicity is thought to result from free radical-induced oxidative damage. Previous reports describe survival after treatment with orally administered NAC, we report the first use of intravenously administered NAC for chloroform ingestion. Acute oral ingestion of chloroform is extremely rare. Our case illustrates that with appropriate supportive care, patients can recover from chloroform ingestion, and intravenously administered NAC may be of benefit in such cases.

Lethal complications after poisoning with chloroform--case report and literature review

Chloroform is a potent central nervous system and respiratory depressant. The toxicities associated with chloroform frequently occur after inhalation. Hepatotoxicity is secondary to production of a toxic metabolite, with a peak elevation of liver enzymes 72 hours after exposure. Acute liver failure after chloroform inhalation is rarely described, this syndrome being produced mainly by viral hepatitis, idiosyncratic drug-induced liver injury, and acetaminophen ingestion. This report describes the case of a 46-year-old woman who presented to emergency department with coma, signs of respiratory failure, and solvent odor of her breath after chloroform inhalation and binge drinking. In evolution appeared lethal acute liver failure and rhabdomyolysis, despite maximum supportive care. Necroptic examination revealed microvesicular steatosis and tubular renal necrosis, specific for chloroform toxicity. This case illustrates the dramatic impact on liver of two well-recognized hepatotoxins. Mechanisms of chloroform and alcohol-induced liver toxicity are reviewed.

A case of acute toxic hepatitis after suicidal chloroform and dichloromethane ingestion

Chloroform and dichloromethane are halogenated hydrocarbons that have been used as a potent anesthetic agent or a general industrial solvent. Short-term exposure to chloroform anesthesia and long-term exposure to chloroform and dichloromethane in workplaces can produce adverse health effects, such as hepatitis, cardiac arrhythmia, and carbon monoxide intoxication. Most of the related reports, however, involve the inhalation of such substances by humans. Limited reports are available regarding the adverse clinical effects of these substances in the case of a person's immediate ingestion of them. A 23-year-old man with an altered mental status after attempting suicide through the oral ingestion of unknown chemicals was brought to the emergency department (ED). We identified that the patient was poisoned with chloroform and dichloromethane by analysis of contents of the suspected chemicals in the bottle through gas chromatography. Abnormal liver enzymes were noted on postingestion day 2, and jaundice occurred on postingestion day 3. The radiologic findings from computed tomographic (CT) scanning showed severe fatty infiltration of the liver parenchyma. The patient received supportive cares and was restored to health from hepatic dysfunction and was discharged without complications after 2 weeks of admission.