Self-poisoning by sodium chlorate--some unusual features

Chlorate poisoning--two cases diagnosed at autopsy

Two cases of chlorate poisoning presenting as unexpected sudden deaths are described. Both cases had previous psychiatric histories but poisoning was not seriously considered as the cause of death prior to autopsy, when the finding of chocolate-coloured fluid blood alerted the pathologist to the cause of death.

Severe chlorate poisoning: report of a case

A case of severe sodium chlorate poisoning was observed within 5 h after suicidal ingestion of 150-200 g of the herbicide. Methaemoglobinaemia was the early symptom of the intoxication. Treatment with methylene blue and ascorbic acid could not prevent a massive haemolysis with disseminated intravascular coagulation. Hypercoagulation and hyperfibrinolysis could be treated successfully with exchange transfusions, heparin and fresh plasma. During the first hours, 70 mmol chlorate were excreted before complete renal failure occurred which required haemodialysis for several weeks. Clinical observations and in vitro experiments provide evidence that methylene blue is effective only in the very early stages of chlorate poisoning. Consequently, the following treatment is suggested: gastric lavage, exchange transfusion, bicarbonate infusion, haemodialysis, anticoagulation with heparin and substitution of clotting factors if necessary.