[Lethal intravenous injection of benzine]. / Intravenöse Injektion von Waschbenzin mit tödlichem Verlauf.

A man who suffered from chronic pain syndrome died two days after intravenous injection of 2 ml benzine. Previous suicide attempts by drug intoxication and strangulation had failed. Death occurred due to multi-organ failure. We present the results of the clinical, morphological and toxicological examinations performed.

Case of multiple organ failure due to benzine ingestion.

A 42-year-old woman was admitted to our ICU for acute respiratory failure due to benzine ingestion. On arrival at the hospital, the patient's consciousness level was GCS 3 and her SpO2 was 89% when receiving oxygen at 10 L/min. She was immediately intubated and placed on a ventilator. Chest X-ray and CT scanning showed a wide infiltrative pulmonary shadow bilaterally, and a diagnosis of acute respiratory distress syndrome (ARDS) was made. Subsequently, she became anuric and required haemodiafiltration on the 2nd day. Complications such as prolonged circulatory failure, liver dysfunction and disseminated intravascular coagulation (DIC) were then observed, and plasma exchange therapy was initiated. The patient's condition improved and a complete recovery ensued. The patient remained suicidal and was moved to the psychiatric ward for psychiatric support. Benzine is purified oil containing aliphatic hydrocarbons and is liquid at room temperature. In this case, the patient had already ARDS that required immediate intubation on arrival at the hospital. On this basis, aspiration of benzine into the lungs was considered to have occurred concomitantly with its ingestion, which therefore led to the complication of chemical pneumonitis in addition to that of circulatory shock, acute kidney injury, liver dysfunction and DIC.

Survival with 98% methemoglobin levels in a school-aged child during the "festival of colors".

Methemoglobin levels more than 70% have almost always been reported to have been fatal. The case of a 4-year-old boy who survived with methemoglobin levels of 98% is presented here. He was brought to the emergency department with complaints of vomiting, pain abdomen, and altered sensorium following accidental ingestion of paint thinner mixed with "Holi" colors. On examination, the child was in altered sensorium, cyanosed with saturations of 55%, who did not respond despite positive pressure ventilation with 100% oxygen. A possibility of toxic methemoglobinemia was considered and confirmed by finding of elevated methemoglobin levels of 98%. The child survived with definitive therapy with methylene blue and aggressive goal-directed approach.

Organic solvent-induced bipolar disorder: a case report.

Many studies have reported neurological and neuropsychiatric symptoms, including a significantly increased risk of depression and suicide, from exposure to low to moderate levels of organic solvents. However, few studies have reported a link between organic solvent exposure and bipolar disorder. The authors present a case of a 43-y-old man who developed new-onset bipolar disorder following exposure to organic solvents in a textile printing plant. The man had elevated blood levels of several common solvents. His symptoms abated following avoidance of solvent exposures at his workplace and after nutritional and sauna detoxification treatments that one of the authors formulated to clear xenobiotics. Following avoidance and detoxification, the patient's blood concentrations of organic solvents fell to undetectable levels and his manic symptoms disappeared, with no significant recurrences over the past 13 y, as evaluated by the authors and his other physicians.

Surfactant therapy in acute respiratory distress syndrome due to hydrocarbon aspiration.

Hydrocarbon aspiration causes acute lung injury, which may lead to acute respiratory distress syndrome. Surfactant has been shown to be beneficial in experimentally-induced hydrocarbon-associated acute respiratory distress syndrome. However, there has not been a clinical study evaluating the effect of surfactant application on hydrocarbon aspiration in humans. We report a 17-month-old boy with acute respiratory distress syndrome due to hydrocarbon aspiration and was successfully treated with surfactant application.

Use of nebulized budesonide in two critical patients with hydrocarbon intoxication.

Reports of acute naphtha (a petroleum distillate) intoxication, particularly those containing treatment and toxicological data, are poorly verified in the literature. Systemic steroids have not usually been advised for routine management, but no previous studies have been reported on the effects of corticosteroid inhalations. In this study, two critical pediatric patients with chemical pneumonia due to naphtha ingestion have been reported who were effectively managed with nebulized budesonide.

Analytical aspects of volatile substance abuse (VSA).

Through a case report, the authors illustrate the volatile substance abuse (VSA) toxicological investigation difficulties mainly due to evaporation of the compounds from postmortem samples and to the lack of reference data for interpretation. A 17-year-old man, student in a chemistry institute, was found dead with a plastic bag placed over his head. Several chemical substances were found in his belongings. Autopsy findings included serious pulmonary lesions and hemorrhagic digestive ulcerations. A large screening of drugs and toxic compounds and selective analyses for several classes of drugs of abuse were carried out in the autopsy samples. In particular, a headspace (HS), -gas chromatography/-mass spectrometry (GC/MS) technique was used to screen for volatile substances and metabolites in the biological samples and for residues of volatile substances on the surface of the plastic bag and in the chemicals found on the scene. The main analytical finding was the presence of alkanes (heptane, methyl-2-pentane, methyl-3-hexane, methylcyclohexane) in the gastric content. The literature data, VSA practices, long time-delay between death and autopsy, preservation conditions of the biological samples before analysis, and in-lab experiments on evaporation of volatile substances were considered to interpret this result. The present fatality was attributed to VSA with a gasoline-based stain remover like "eau écarlate," associated with a hypoxic recreation practice using a plastic bag.

Acute massive rhabdomyolysis due to prolonged inhalation of liquid gas.

A very rare case of non-fatal acute massive rhabdomyolysis caused by unintentional prolonged inhalation of liquid gas (consisting of butane and propane) in a previously healthy adult is presented. The immediate diagnosis and intensive symptomatic therapy prevented any other severe complications of rhabdomyolysis, and the patient made a complete recovery without any sequelae.

Acute myocardial infarction and renal failure following naphtha ingestion.

We present a case of a non-Q wave myocardial infarction and acute renal failure following an ingestion of naphtha, a petroleum distillate composed primarily of hydrocarbons. The patient's renal, metabolic, and cardiac status improved over several days with aggressive volume replacement and bicarbonate therapy. Acute cardiotoxic effects of hydrocarbon exposure generally manifest as dysrhythmias, secondary to myocardial sensitization to circulating catecholamines, or, possibly, coronary vasospasm. Ischemia from associated hypotension or direct myocardial toxicity are other potential causes of naphtha-related cardiac injury.

[Acute poisoning with industrial products]. / Intoxications aiguës par les produits industriels.

Poisonings with industrial products represent approximately 7% of the cases reported to the poison centres. Ingestion of petroleum distillates induces irritation of the gastrointestinal tract, central nervous system depression and aspiration pneumonitis which may be severe; treatment is mainly supportive. Ethylene and diethylene glycol poisonings produce central nervous system depression, anion gap metabolic acidosis, osmolar gap and acute tubular necrosis; in severe cases, hypocalcaemia, cerebral oedema and heart failure may be observed; treatment often associates supportive measures, haemodialysis and administration of competitive inhibitors of alcohol dehydrogenase (ethanol or 4-methylpyrazole). Glycol ethers induce central nervous system depression and metabolic acidosis; in addition, ethylene glycol monobutyl ether produces haemolysis; monomethyl and monoethyl ethers are responsible for bone marrow and lymphoid organ toxicity, they adversely affect spermatogenesis and are teratogens.

A fatal case of oral ingestion of benzine.

A young woman committed suicide by ingesting benzine. We report the findings obtained at autopsy and the chemical analyses of the gastric contents, blood, and tissues in this case. Fatal concentrations of n-hexane, benzene, toluene and m-, p-xylene were detected. Pulmonary edema and hemorrhage were caused by the primary effect of the chemicals or secondarily by respiratory depression, suffocation due to volatile fluid, or heart failure. Mild hemorrhage around arterioles and venules in the brain cortex suggest hyperpermeability of the vessels. The fragmentation and waviness of the cardiac myofibrils indicate the presence of hypercontraction and possibly arrhythmia.

[Cerebellar syndrome after long-term exposure to organic solvents. Case report]. / Zespól mózdzkowy po wieloletnim narazeniu zawodowym na rozpuszczalniki organiczne. Opis przypadku.

A clinical picture of cerebellar syndrome with cerebellar atrophy revealed by CT scan in a worker for 28 years occupationally exposed to petrol and trichloroethylene vapours has been described. The relationship between the illness and the occupational exposure to the organic solvents has been discussed.

Mis-swallowing of cleaning naphtha: report of three cases.

Cleaning naphtha, a product of Chinese Petroleum Corporation, is a complex hydrocarbon mixture which contains mainly aliphatic hydrocarbons. It is used as a cleaning fluid and solvent. Three toddlers mis-swallowed a mouth of cleaning naphtha accidentally. One developed multiple organ failure before death, another completely recovered without sequelae, and the other died very soon after mis-swallowing. Two fatal cases were both induced vomiting with aspiration immediately after mis-swallowing by their parents. Therefore, inducing vomiting should not be encouraged especially at home, and prevention of aspiration is very important in the management of such cases.

The effect of restricting access to lethal methods for suicide: a study of suicide by domestic gas in Japan.

Data from Japan from 1969 to 1982 indicated that, as domestic gas was detoxified, its use for suicide declined. In addition, there was no evidence that would-be suicides switched to alternative methods for suicide. The results were interpreted as support for a recent suggestion that preventing access to lethal methods for suicide may prevent suicide.

Fulminant hepatic failure after occupational exposure to 2-nitropropane.

Two construction workers became ill after applying an epoxy resin coating containing 2-nitropropane in the confined space of an underground concrete vault. One man died 10 days later from fulminant hepatic failure. The second man recovered but has had persistently elevated serum aminotransferase activity. The serum concentration of 2-nitropropane on admission of the man who died was 13 mg/L, and was 8.5 mg/L in his coworker. The acute toxicity of 2-nitropropane has not been widely appreciated despite previous reports of death due to hepatic failure after exposure to the compound in confined spaces. These cases show the importance of effective education and protective work practices.

Abnormal n-nonacosane storage in humans: detection by gas chromatography/mass spectrometry of tissue extracts.

We report a case of n-nonacosane storage disease, which went undiagnosed until the death of a 55-year-old farmer. Clinical, histological, and biochemical features are discussed. n-Nonacosane storage was identified by gas chromatographic-mass spectrometric analysis of different tissue extracts, n-nonacosane concentration reaching 1.2 mg g-1 of lung tissue and 0.32 mg g-1 of liver tissue. It was possible to rule out a work-induced intoxication, and n-nonacosane storage appeared to be accounted for by a lifelong, heavy consumption of unpeeled apples and Brussels sprouts.

[Poisoning caused by Eau Ecarlate: apropos of a fatal case in a child]. / Intoxication par l'Eau Ecarlate: à propos d'un cas mortel chez l'enfant.

A 19 months child was accidentally poisoned by ingestion of "eau écarlate", a gasoline-based cleaner. He died half an hour later with an acute pulmonary necrosis, caused by inhalation of gasoline. The authors describe the toxicity of petroleum poisoning and attempt to edict standards for medical transportation of children with petroleum accidental absorption.