ABSTRACT
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.
Subject(s)
Acidosis/chemically induced , Mouthwashes/poisoning , Multiple Organ Failure/chemically induced , Phenols/poisoning , Salicylates/poisoning , Terpenes/poisoning , Acidosis/diagnosis , Acidosis/therapy , Alcoholism/complications , Anti-Infective Agents, Local/poisoning , Autopsy , Cause of Death , Critical Care/methods , Drug Combinations , Drug Overdose , Eucalyptus/poisoning , Fatal Outcome , Fixatives/poisoning , Humans , Male , Menthol/poisoning , Middle Aged , Mouthwashes/chemistry , Multiple Organ Failure/diagnosis , Multiple Organ Failure/therapy , Renal Dialysis , Respiration, Artificial , Risk Factors , Salicylates/chemistry , Severity of Illness Index , Terpenes/chemistry , Thymol/poisoningABSTRACT
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.
