Fatal case of commercial moisture absorber ingestion

Abstract

DesCripTionOne of the most commercially available moisture absorbers is a dehydrating agent containing calcium chloride. In humid environments such as basements, kitchens, cabinets and closets, calcium chloride provides effective moisture absorption by becoming highly concentrated calcium chloride brine. Ingestion of calcium chloride can lead to severe hypercalcaemia and can be fatal. In our case, hypercalcaemia developed from intentional ingestion of moisture absorber and the patient eventually died. To our knowledge, fatality from commercial moisture of absorber ingestion has not been reported. A 31-year-old man presented to the emergency department (ED) 20 min after intentionally ingesting 300 mL of commercial moisture absorber solution. It contained 300 g of calcium chloride (figure 1). The patient had a history of a pervasive developmental disorder. When the patient first presented to ED, he was alert. The patient's initial symptoms were nausea and vomiting. Gastric lavage was done, and activated charcoal was used. Although initial vital signs were relatively stable, initial ECGs revealed sinus bradycardia (36 bpm), with corrected QT interval of 421 ms (<430 ms) which, in subsequent study, increased to 512 ms. The results of the laboratory studies were as follows: serum total calcium 20.7 mg/ dL (8.2-10.8 mg/dL), ionised calcium 3.82 mmol/L (1.13-1.32 mmol/L), blood urea nitrogen 18.9 mg/ dL (7.8-22.0 mg/dL), creatinine 0.78 mg/dL (0.7-1.2 mg/dL), albumin 4.2 g/dL (3.1-5.2 g/dL), phosphorus 5.3 mg/dL (2.5-5.5 mg/dL), creatine kinase 94 IU/L (38-174 IU/L), sodium 139 mmol/L, potassium 4.0 mmol/L and chloride 107 mmol/L. Blood analysis results were pH 7.37, paCO 2 45 mm Hg, paO 2 81 mmHg and bicarbonate 26 mmol/L on room air. Urinary calcium excretion was not measured. Patient was given adequate normal saline, pamidronate and then furosemide intravenously. The second arterial blood gas analysis was done 1 hour and 40 min after the patient's arrival. pH of 7.25, PaCO 2 43 mm Hg, PaO 2 123 mm Hg and bicarbonate 18.9 mmol/L were measured. For the treatment of advanced metabolic acidosis, we had to manage it with haemodialysis. At that time, however, there was no continuous renal replacement therapy (CRRT) equipment available at our hospital, so the patient had to be transferred to nearby hospital. CRRT device w as applied immediately after the patient's transfer, but unfortunately symptoms. did not improve. On the fifth day of hospitalisation, the patient eventually died of multiple organ failure. Hypercalcaemia has many causes; more than 90% of cases result from primary hyperthyroidism or malignancy. Other causes of hypercalcaemia include chronic lithium therapy, thiazide diuretics, pheochromocytoma, adrenal insufficiency, theophylline toxicity and vitamin D poisoning, 2 and there was a fatal case of hypercalcaemia due to calcium channel blocker ingestion. In general, treatment of hypercalcaemia is aimed at lowering serum calcium levels. Despite best efforts, the patient remained in shock with signs of renal fa...

Cardiac Manifestations after Ingestion of a Commercial Desiccant: A Case Report

“…In several case reports about dehumidifier-related poisoning, patients presented with severe intestinal injuries that required surgical emergency intervention, severe metabolic acidosis necessitating CRRT, and even fatal outcomes [8][9][10]. Fortunately, our patient recovered with only supportive care.…”

“…Deliberate intoxication with chemical substances, excluding certain agricultural products, is rarely reported, and commercial products like dehumidifying agents that contain calcium chloride (CaCl 2 ) as their main ingredient are commonly used. Although cases of CaCl 2 intoxication have been reported, most consist of gastric necrosis with or without surgical treatment and metabolic acidosis that requires continuous renal replacement therapy (CRRT) [8][9][10]. Even though CaCl 2 is known as a strong stimulant of the skin and mucous membrane, massive CaCl 2 ingestion accidents sometimes occur, especially in patients with developmental disorders or dementia.…”

Severe hypercalcaemia due to household cleaner ingestion

“…Several other substance ingestions have been associated with hypercalcaemia. These include nicotine-replacement gum, carbonated water, enteric feeding formula, commercial moisture absorber, hot packs, liquid calcium fertiliser, oyster shell powder used with betel nuts and massive quantities of cheese 3 9–13. The amount of calcium ingested and peak serum calcium level of these cases are presented in table 2.…”