N-acetylcysteine and hemodialysis treatment of a severe case of methyl ethyl ketone peroxide intoxication

Abstract

The plastic hardener methyl ethyl ketone peroxide (MEKP) is an unstable peroxide that releases free oxygen radicals. Ingestion of this compound induces widespread liver necrosis that is often fatal, extensive ulceration with subsequent scarring, and stenosis of the proximal digestive tract in survivors. Severe metabolic acidosis occurs due to the accumulation of formic acid and other organic acids inducing neurologic damage, such as optic nerve lesions. A 53-year-old man unintentionally ingested approximately 120 ml of a 33% solution of this compound in dimethylphtalate. The patient was treated with the free radical scavenger N-acetylcysteine to counteract free radical-mediated damage and with hemodialysis to remove accumulated organic acids. Although our patient demonstrated considerable edema and ulceration of the distal esophagus, stomach and duodenum in the acute phase, there was never any sign of liver damage or neurological damage, nor were there any demonstrable lesions in the proximal digestive tract three weeks after the event. Treatment with a combination of N-acetylcysteine and haemodialysis may be a promising therapy for this severe and potentially life-threatening intoxication.

Narrowing of airway caused by ingestion of methyl ethyl ketone peroxide

“…2 First, there are the airway and the gastrointestinal signs. In the acute phase, an airway edema may be the cause of death.…”

A case of methyl ethyl ketone peroxide poisoning and a review of complications and their management

“…These include inflammation and ulceration of exposed gastrointestinal tract, acute oxidative liver injury, complications of formation of organic acids including metabolic acidosis and secondary acute complications. Secondary complications include acute renal failure secondary to rhabdomyolysis, ventilator assisted pneumonia, myocarditis and acute respiratory distress syndrome [ 9 ].…”

“…Long term problems such as esophageal strictures requiring multiple endoscopic dilatations has been reported [ 5 ]. Liver failure due to oxidative hepatocyte injury is the most significant single cause of mortality in the previous case reports [ 4 , 9 , 12 , 13 ]. Reversible acute kidney injury (AKI) has been reported in almost a third of published case studies.…”

Gastric emphysema after methyl ethyl ketone peroxide ingestion

“…Twentythree cases of MEKP ingestion have been reported in the medical literature. 1 Among these, almost all the patients showed upper GI tract injury, and six patients died from complications.…”

“…Because of its free radical production and lipid peroxidation, MEKP causes severe corrosive injury in the upper gastrointestinal (GI) tract and also liver necrosis. 1,2 Various organic acids are produced in the process of MEKP decomposition, and these organic acids lead to complications such as metabolic acidosis and optic nerve toxicity. Twentythree cases of MEKP ingestion have been reported in the medical literature.…”