Fatal large-volume mouthwash ingestion in an adult: a review and the possible role of phenolic compound toxicity.

OBJECTIVE: To describe a case of fatal mouthwash ingestion and review possible sources of toxicity. DESIGN: Case report. SETTING: Veterans Administration Medical Center. PATIENT: Single patient with massive mouthwash ingestion. MAIN RESULTS: This patient was a 45-year-old man who developed cardiovascular collapse and multiorgan system failure following a massive ingestion of mouthwash (almost 3 liters). His presentation was remarkable for a profound anion-gap metabolic acidosis and a significant osmolar gap. No other co-ingestants were identified, and he expired despite full supportive care including dialysis and mechanical ventilation. An autopsy failed to identify any other cause of death. Nonalcoholic ingredients of this mouthwash are phenolic compounds (eucalyptol, menthol, and thymol), and large-volume mouthwash ingestion will produce exposure in the reported toxic range of these ingredients. CONCLUSIONS: When ingested in large quantities, the phenolic compounds in mouthwash may contribute to a severe anion-gap metabolic acidosis and osmolar gap, multiorgan system failure, and death. These compounds, in addition to alcohol, may account for the adverse effects associated with massive mouthwash ingestion.

Multiple organ failure after ingestion of pennyroyal oil from herbal tea in two infants.

BACKGROUND: Hepatic and neurologic injury developed in two infants after ingestion of mint tea. Examination of the mint plants, from which the teas were brewed, indicated that they contained the toxic agent pennyroyal oil. METHODS: Sera from each infant were analyzed for the toxic constituents of pennyroyal oil, including pulegone and its metabolite menthofuran. RESULTS: Fulminant liver failure with cerebral edema and necrosis developed in the first infant, who died. This infant was positive only for menthofuran (10 ng/mL). In the other infant, who was positive for both pulegone (25 ng/mL) and menthofuran (41 ng/mL), hepatic dysfunction and a severe epileptic encephalopathy developed. CONCLUSION: Pennyroyal oil is a highly toxic agent that may cause both hepatic and neurologic injury if ingested. A potential source of pennyroyal oil is certain mint teas mistakenly used as home remedies to treat minor ailments and colic in infants. Physicians should consider pennyroyal oil poisoning as a possible cause of hepatic and neurologic injury in infants, particularly if the infants may have been given home-brewed mint teas.

A survey of neonatal jaundice in association with household drugs and chemicals in Nigeria.

A survey was conducted to determine the extent of exposure of women of child-bearing age and their families to household chemicals and medicaments, and the prevalence of neonatal jaundice in the exposed and unexposed families compared. Significant exposures to naphthalene, insecticides, mentholated balms, mentholated powders, and traditional herbs occurred in 45-87% of the families studied. The overall incidence of jaundice did not differ significantly in neonates from households with or without positive history of drugs/chemical exposures. Severe neonatal jaundice, as judged by the need for exchange blood transfusion or death of the infant, was however, significantly more frequent among neonates from families with positive history of naphthalene exposure than in those with negative history. Some household chemicals and medicaments may be important in the pathogenesis of neonatal jaundice in our environment, and health education aimed at eliminating exposure neonates and pregnant women to such agents is urgently necessary.

[Acute poisoning of an infant by cutaneous application of a local counterirritant and pulmonary antiseptic salve]. / Intoxication aiguë du nourrisson par application cutanée d'une pommade révulsive locale et antiseptique pulmonaire

The case of acute poisoning reported here raises the question of the harmlessness of preparations destined for cutaneous application in infants. After describing the method perfected for the identification and estimation of camphor, menthol and thymol in biological material, the authors present the toxicological, clinical and biological arguments in favour of the notion that the cutaneous resorption of these substances was responsible for this acute intoxication in an infant. Particular attention should be paid to poisoning which may result, in the newborn and infant, from the cutaneous application of active substances.