A case of fatal benzalkonium chloride poisoning

Hitosugi, Masahito; Maruyama, Kentaro; Takatsu, Akihiro

doi:10.1007/s004140050166

Cited by 52 publications

(47 citation statements)

References 7 publications

(11 reference statements)

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“…Complications from these types of ingestions include-although rare-caustic burns to the mouth and esophagus, transaminase elevations, metabolic acidosis, and central nervous system depression. Muscle paralysis (which was not seen in our patient) following ingestions of quaternary ammonium compounds has been described and is presumed to be likely due to cholinesterase inhibition at the neuromuscular junction [12].…”

Section: Discussionsupporting

confidence: 50%

“…Fatal ingestions due to 0.2% concentration may have pHs high enough to significantly increase the risk of serious esophageal burns, although other factors also contribute to risk of esophageal damage [11]. Fatalities from ingestions of aqueous solutions of benzalkonium chloride have rarely been reported and usually involve products of greater than 10% concentration [12]. Complications from these types of ingestions include-although rare-caustic burns to the mouth and esophagus, transaminase elevations, metabolic acidosis, and central nervous system depression.…”

Section: Discussionmentioning

confidence: 99%

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A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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Introduction: Unintentional ingestions of dilute (<7.5%) cleaning solutions containing ammonium chloride typically do not cause serious harm. We present a case of an intentional ingestion of a dilute ammonium chloride solution resulting in significant morbidity.Case Report: A 60-year-old woman with bipolar disorder presented one hour after an intentional ingestion of approximately 15 fluid ounces (500 mL) of an algae and odor humidifier treatment containing a total of 2.25% ethyl ammonium chloride. Initial complaints included nausea with a single episode of nonbilious, nonbloody emesis, mild shortness of breath, and chest and epigastric pain. Physical exam was remarkable for bilateral wheezing and epigastric tenderness. An emergent endoscopy demonstrated a Grade 2b caustic injury in the esophagus and a Grade 3b injury in the stomach. Due to persistent cough, copious oral secretions, and worsening hoarseness, the patient was intubated and admitted to the ICU. Her course was complicated by mild hypotension, nonanion gap metabolic acidosis, and oliguria treated successfully with intravenous (IV) fluids. She also developed bilateral pneumonias later in the hospital course. Bedside bronchoscopy showed laryngeal edema and mucosal injury to the segmental level. The patient underwent tracheostomy on hospital day 6. An upper GI swallow study revealed poor esophageal motility in the mid-to lower third of the esophagus. The patient gradually tolerated oral fluids and on hospital day 20 had her tracheostomy tube removed. The patient was subsequently transferred to the psychiatric ward on hospital day 22.Conclusion: Intentional ingestions of dilute ammonium chloride solutions can cause serious injury to the gastrointestinal tract and pulmonary systems, which can result in a complicated and prolonged hospitalization.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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“…In some cases, the use of a BAC-containing product for its intended purpose caused a severe allergic reaction of the skin [16] and eye conjunctiva [17]. There are a number of reports of accidental exposure of humans to BAC, which led to death or a serious injury [18][19][20]. A major route of human exposure to this toxic compound is inhalation.…”

Section: Introductionmentioning

confidence: 99%

Toxic effect in the lungs of rats after inhalation exposure to benzalkonium chloride

Świercz¹,

Hałatek²,

Stetkiewicz³

et al. 2013

International Journal of Occupational Medicine and Environmental Health

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Background: Benzalkonium chloride (BAC) is a quaternary ammonium compound (QAC) toxic to microorganisms. Inhalation is one of the major possible routes of human exposure to BAC. Materials and Methods: Experiments were performed on female Wistar rats. The rats were exposed to aerosol of BAC water solution at the target concentration of 0 (control group) and 35 mg/m 3 for 5 days (6 h/day) and, after a 2-week interval, the animals were challenged (day 21 ) with BAC aerosol at the target concentration of 0 (control group) and 35 mg/m 3 for 6 h. Results: Compared to the controls, the animals exposed to BAC aerosol were characterized by lower food intake and their body weight was significantly smaller. As regards BAC-exposed group, a significant increase was noted in relative lung mass, total protein concentration, and MIP-2 in BALF both directly after the termination of the exposure and 18 h afterwards. Significantly higher IL-6 and IgE concentrations in BALF and a decrease in the CC16 concentration in BALF were found in the exposed group immediately after the exposure. The leukocyte count in BALF was significantly higher in the animals exposed to BAC aerosol compared to the controls. In the lungs of rats exposed to BAC the following effects were observed: minimal perivascular, interstitial edema, focal aggregates of alveolar macrophages, interstitial mononuclear cell infiltrations, thickened alveolar septa and marginal lipoproteinosis. Conclusion: Inhalation of BAC induced a strong inflammatory response and a damage to the blood-air barrier. Reduced concentrations of CC16, which is an immunosuppressive and anti-inflammatory protein, in combination with increased IgE concentrations in BALF may be indicative of the immuno-inflammatory response in the animals exposed to BAC aerosol by inhalation. Histopathological examinations of tissue samples from the BAC-exposed rats revealed a number of pathological changes found only in the lungs.

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“…Various alterations of the gastrointestinal mucosa associated with fatal poisoning by orally ingested substances are well known including for example discolouration by chromate compounds [1], oedema and diffuse gastric hemorrhage following mercury oxycyanide ingestion [2], gastritis caused by chloralhydrate overdose and mercuric compounds [3,4], erosion following benzalkonium chloride poisoning [5] and metaphasic mitotic figures in gastric and small bowel epithelium due to colchicine poisoning [6]. Additionally, suspicious gastric contents, e.g.…”

Section: Discussionmentioning

confidence: 99%

Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning

Sperhake

Tsokos

Sperhake

1999

International Journal of Legal Medicine

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Two cases of fatal oral poisoning are presented. In the first case, a 40-year-old man died due to a lethal dose of mercury (blood concentration 113.8 microg/ml) and in the second, a 34-year-old man died of chloralhydrate overdose with a lethal blood concentration of trichloroethanol (52 microg/ml), the active metabolite of chloralhydrate. In both cases gross examination and histology showed an unusually well preserved gastrointestinal mucosa in addition to unspecific signs of intoxication. The two cases demonstrate that the phenomenon of perimortal fixation is a useful indication for the forensic pathologist and should direct the suspicion to oral poisoning. The detection of fixation facilitates toxicology screening by indicating that the relevant substance must have the capability to precipitate proteins.

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A case of fatal benzalkonium chloride poisoning

Cited by 52 publications

References 7 publications

A complicated hospitalization following dilute ammonium chloride ingestion

A complicated hospitalization following dilute ammonium chloride ingestion

Toxic effect in the lungs of rats after inhalation exposure to benzalkonium chloride

Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning

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