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Muacevic A, Adler JR, Atogwe ID, Bhandari S, Balasubramanian P, Ronderos DM. Nail Polish Remover Induced Methemoglobinemia: An Uncommon Occurrence. Cureus 2022; 14:e32107. [PMID: 36601139 PMCID: PMC9805361 DOI: 10.7759/cureus.32107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite. We present a case of methemoglobinemia in an 81-year-old male following accidental ingestion of isobutyl nitrite-containing nail polish remover, commonly used as a recreational inhalant. Furthermore, we review potentially toxic substances found in commercially available nail products. This case was designed to identify and efficiently treat a rather uncommon cause of methemoglobinemia induced in this case by a common household item, nail polish remover.
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Sun C, Jian T, Li Y, Cui S, Shi L, Yu G, Kan B, Jian X. A rare form of intoxication: acute methyl ethyl ketone peroxide poisoning. J Int Med Res 2022; 50:3000605211067694. [PMID: 34994585 PMCID: PMC8743954 DOI: 10.1177/03000605211067694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report two suicidal cases of acute methyl ethyl ketone peroxide (MEKP) poisoning. A woman in her late 60s suffered from oral mucosal erosion, functional impairment of the heart, liver and other organs, pulmonary inflammation, elevated inflammatory markers, pleural effusion, hypoproteinemia and metabolic acidosis after oral administration of approximately 50 mL of MEKP. After admission, the patient was administered hemoperfusion four times, 8 mg of betamethasone for 6 days and symptomatic support. Hemoperfusion had an obvious effect on the treatment of oral MEKP poisoning. After discharge, the patient developed progressive dysphagia and secondary esophageal stenosis. Supplementary feeding was administered with a gastrostomy tube after the patient was completely unable to eat. A man in his mid-40s developed oropharyngeal mucosal erosion, bronchitis and esophageal wall thickening after oral administration of 40 ml MEKP. After receiving total gastrointestinal dispersal, 80 mg of methylprednisolone was administered for 7 days, and symptomatic supportive treatment was provided. Slight dysphagia was observed after discharge, and there was no major effect on the quality of life. Patients with acute oral MEKP poisoning should be followed up regularly to observe its long-term effects on digestive tract corrosion and stenosis.
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Affiliation(s)
- Cece Sun
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,School of Public Health, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, China
| | - Longke Shi
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,School of Public Health, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Baotian Kan
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, 12589Shandong University, Emergency Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Dhir A, Kaur B, Syal A, Gupta M, Mehdi Z. A Case of Methyl Ethyl Ketone Peroxide Ingestion Complicated by Rhabdomyolysis. Cureus 2020; 12:e12119. [PMID: 33489533 PMCID: PMC7810179 DOI: 10.7759/cureus.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Methyl ethyl ketone peroxide (MEKP) is a colorless-to-faintly-yellow liquid that is used as a cross-linking to harden plastics or resins in various industries. It is also an ingredient of paints, varnishes, and paint removers. Because of the high reactivity of MEKP, it is available only as a 40% to 60% solution in dimethyl phthalate or other phthalates. Post-ingestion, the spectrum of complications is vast, ranging from corrosive injury in the oral cavity and gastrointestinal tract to fulminant hepatic toxicity, sepsis, multi-organ failure, and disseminated intravascular coagulation. We report the case of a 40-year-old, self-employed, male worker in a lamination workshop, who presented with accidental ingestion of MEKP from an unlabeled container. He subsequently developed a multitude of complications, most noteworthy being rhabdomyolysis and in turn acute kidney injury. The patient was managed in the intensive care unit with supportive management and hemodialysis sessions; however, the patient succumbed to his illness, despite aggressive measures.
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Bairros AV, Saldanha GA, Berlato DG, Moraes LS, Gündel AR, Carvalho JAM, Habib IA, De Carli DM, Oliveira TF, Oliveira SCWSEF. Accidental ingestion of methyl ethyl ketone peroxide: N-acetylcysteine treatment and toxicological analysis. Clin Chim Acta 2020; 511:47-49. [PMID: 33002473 DOI: 10.1016/j.cca.2020.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Methyl ethyl ketone peroxide (MEKP) is a highly toxic product which promotes tissue damage by uncontrolled free radical production. CASE REPORT A man accidentally ingested 110 ml of MEKP (37%) at his workplace after mistaking it with a bottle of water. A loading dose of N-acetylcysteine (NAC) and subsequent maintenance doses were applied at the hospital for three consecutive days. Biochemical and hematological parameters showed significant alterations. Tracheal intubation, gastric lavage and hemodialysis were not performed. Methyl ethyl ketone (MEK) and MEKP were detected in EDTA-blood samples by GC-FID and LC-QTOF/MS respectively. An endoscopy exam identified tissue damage. The patient was admitted to the hospital for 10 days. No sequelae were reported after the MEKP poisoning. Oral administration of NAC was successful as an antidote without another approach. CONCLUSIONS Although NAC treatment was successful, supervision after the hospitalization period was required according to the prognosis. Workplace conditions promoted anosmia, explaining the accident. MEKP and MEK were successfully detected in blood samples even with less-than-ideal storage conditions. Knowledge of MEKP dangerousness and good work practices can prevent accidental MEKP poisoning.
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Affiliation(s)
- André V Bairros
- Nucleus Applied to Toxicology, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, Brazil.
| | - Geovane A Saldanha
- Nucleus Applied to Toxicology, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Dener G Berlato
- Nucleus Applied to Toxicology, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Liliana S Moraes
- Nucleus Applied to Toxicology, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Augusto R Gündel
- Laboratory of Clinical Analysis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil
| | - José A M Carvalho
- Laboratory of Clinical Analysis, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil
| | - Isabela A Habib
- Gastroenterology Unit, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil
| | - Diego M De Carli
- Gastroenterology Unit, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil
| | - Tiago F Oliveira
- Mass Spectrometry Research Group, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Sarah C W S E F Oliveira
- Mass Spectrometry Research Group, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Arp FF, Ahn SH, Bhuvanesh N, Blümel J. Selective synthesis and stabilization of peroxides via phosphine oxides. NEW J CHEM 2019. [DOI: 10.1039/c9nj04858h] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
MEKPO (methyl ethyl ketone peroxide) and other peroxides can be synthesized selectively and stabilized as hydrogen-bonded phosphine oxide adducts.
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Affiliation(s)
- Fabian F. Arp
- Department of Chemistry
- Texas A&M University
- College Station
- USA
| | - Shin Hye Ahn
- Department of Chemistry
- Texas A&M University
- College Station
- USA
| | | | - Janet Blümel
- Department of Chemistry
- Texas A&M University
- College Station
- USA
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Liang S, Hou Z, Li X, Wang J, Cai L, Zhang R, Li J. The fecal metabolome is associated with gestational diabetes mellitus. RSC Adv 2019; 9:29973-29979. [PMID: 35531557 PMCID: PMC9072113 DOI: 10.1039/c9ra05569j] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/11/2019] [Indexed: 01/02/2023] Open
Abstract
Dysbiosis of gut microbiota has been linked to gestational diabetes mellitus (GDM), and grows as a resource for GDM biomarkers. However, the contributions of gut microbiota to GDM remain incompletely understood. Metabolites are key messengers in the interactions between gut microbiota and the host. Metabolomics is emerging as an essential tool in exploring the contributions of gut microbiota to diseases. In this study, we performed 1H-NMR based metabolomics on the feces of 62 pregnant women, including 31 women with GDM, and 31 women as the non-diabetes (NDM) control. Using Principle Component Analysis (PCA) and Orthogonal Projection to Latent Structures Discrimination Analysis (OPLS-DA), we observed clear cluster separation of the fecal metabolome between women with GDM and the NDM control. We further applied several feature selection methods to find five fecal metabolites contributing to the cluster separation of the fecal metabolome. These five metabolites, namely dibutyl decanedioate, N-acetylgalactosamine-4-sulphate, homocysteine, l-malic acid, and butanone, were significantly correlated with the clinical indices of GDM. Metabolite enrichment and pathway analysis on the five metabolites suggested that the fecal citrate cycle and sulfur metabolism were correlated with GDM. The results of this study demonstrated that disorders in the fecal metabolome are associated with GDM. Fecal metabolome could separate women with GDM from the non-diabetic control.![]()
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Affiliation(s)
- Shufen Liang
- The Second Hospital of Shanxi Medical University
- Taiyuan 030001
- PR China
| | - Ziqi Hou
- The Second Clinical Medical College of Shanxi Medical University
- Taiyuan 030001
- PR China
| | - Xue Li
- The Second Clinical Medical College of Shanxi Medical University
- Taiyuan 030001
- PR China
| | - Juan Wang
- The Second Clinical Medical College of Shanxi Medical University
- Taiyuan 030001
- PR China
| | - Lijun Cai
- The Second Hospital of Shanxi Medical University
- Taiyuan 030001
- PR China
| | - Runping Zhang
- Children's Hospital of Shanxi
- Women Health Center of Shanxi
- Taiyuan 030001
- PR China
| | - Jianguo Li
- Institutes of Biomedical Sciences
- Shanxi University
- Taiyuan 030006
- PR China
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Chang JO, Choi JW, Hwang Y. A case of severe corrosive esophagitis, gastritis, and liver necrosis caused by ingestion of methyl ethyl ketone peroxide. Clin Exp Emerg Med 2017; 3:256-261. [PMID: 28168233 PMCID: PMC5292296 DOI: 10.15441/ceem.15.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 11/23/2022] Open
Abstract
The plastic hardener methyl ethyl ketone peroxide is unstable peroxide that releases free oxygen radicals. Ingestion of this compound induces widespread liver necrosis, severe metabolic acidosis, corrosive esophagitis and gastritis, that is often fatal. A 49-year-old man unintentionally ingested approximately 100 mL (55%) of this compound in solution, which was purchased as plastic hardener. Despite resuscitation, he died about 11 hours after admission. We report a patient with poisoning due to methyl ethyl ketone peroxide who presented with corrosive esophagitis and gastritis, gastrointestinal bleeding, and developed ischemia of the bowel and necrosis of the liver and died of severe metabolic acidosis and multiorgan failure.
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Affiliation(s)
- Jung Oh Chang
- Department of Emergency Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Jeong Woo Choi
- Department of Emergency Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Yong Hwang
- Department of Emergency Medicine, Wonkwang University Hospital, Iksan, Korea
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