Complex poisoning mainly with benzyl alcohol complicated by paralytic ileus: a case report

Abstract

Background Benzyl alcohol is used as stripping agent in paints and other applications, and benzyl alcohol poisoning is indicated by symptoms, such as impaired consciousness, respiratory depression, hypotension, metabolic acidosis, and renal dysfunction. Case presentation A 27-year-old Asian man was transported to a hospital for severe disturbance of consciousness following exposure to a paint stripper containing benzyl alcohol, ethylene glycol, and hydrogen peroxide, which he was using to repaint a bridge. The patient was treated under sedation for benzyl alcohol poisoning. On day 3 of hospitalization, his abdominal computed tomography scan revealed a paralytic ileus, so he was transferred to our hospital. The combined toxicity from multiple substances, mainly benzyl alcohol, was thought to be a contributing factor for the paralytic ileus. Upon arrival, the patient also had chemical burns, hypernatremia, and elevated myogenic enzyme levels. His urinary hippuric acid level was high (14.9 g/L) upon admission to the previous hospital. We treated the patient with artificial respiration management, while avoiding high-density oxygen, and with gastrointestinal decompression by gastric tube implantation; laxatives were also administered. The paralytic ileus improved on the 4th day, the tube was removed on the 6th day, and the patient was discharged on the 11th day of hospitalization. No apparent complications were observed at discharge. Conclusions To the best of our knowledge, this is the first case report of paralytic ileus caused by benzyl alcohol, although multiple factors may have influenced the symptoms. After exposure to benzyl alcohol by inhalation and dermal absorption, the patient developed impaired consciousness, metabolic acidosis, and paralytic ileus, and the presence of elevated urinary hippuric acid led to a definitive diagnosis.

Acute benzyl alcohol intoxication: An autopsy case report

“…Vacuolar degeneration may be a sign of benzyl alcohol exposure as shown by a previous case report. [ 2 ] Additionally, the degeneration of the bronchial mucosa may be pathological evidence of inhalation of benzyl alcohol in the present case. Exposure by inhalation and transdermal absorption may be associated with rapid progression of acute intoxication.…”

“…Renal tubular dysfunction is considered to be a major complication, and associated symptoms are metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. [ 2 , 3 ] We could not evaluate renal tubular function and electrolyte values because the victim was already critical on admission. However, the pathological appearance of the kidney did not show degeneration of the tubular epithelium.…”

“…Benzyl alcohol is a metabolite of toluene and is oxidized by an alcohol-depleting enzyme in the liver that produces benzoic acid. [ 1 , 2 ] Benzoic acid is then combined with glycine and excreted in urine as hippuric acid. [ 1 ] Benzyl alcohol is an ingredient in many paint removers and other industrial applications, and is even found in cosmetic products and food additives.…”

“…[ 1 ] Benzyl alcohol is an ingredient in many paint removers and other industrial applications, and is even found in cosmetic products and food additives. [ 2 ] There have been few case reports on benzyl alcohol intoxication in adults, and these cases showed impaired consciousness, respiratory depression, hypotension, metabolic acidosis, renal dysfunction, hypothermia, paralytic ileus, and hyperammonemia. [ 2 , 3 ] However, autopsy reports of cases of benzyl alcohol intoxication have not been published.…”

“…[ 2 ] There have been few case reports on benzyl alcohol intoxication in adults, and these cases showed impaired consciousness, respiratory depression, hypotension, metabolic acidosis, renal dysfunction, hypothermia, paralytic ileus, and hyperammonemia. [ 2 , 3 ] However, autopsy reports of cases of benzyl alcohol intoxication have not been published. Therefore, the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated.…”