methyl ethyl ketone peroxide poisoning
Published by on November 13, 2020
It is a strong oxidizing agent and a corrosive. 2001;108(2):473–6. Authors of this case study do not have competing interests. al described the clinical features of acute intoxication in four categories. Upper gastrointestinal endoscopy performed on day 28 revealed inflammatory lesions extending from upper esophagus to duodenum. statement and In the absence of esophageal perforation, insertion of nasogastric tube before the onset of edema was useful in managing this patient. It is a strong oxidizing agent and a corrosive. Serum potassium was elevated at 6.4 mmol/L, which persisted through the first week of hospital stay. There were slough, exudate and fibrotic bands but significant stricture formation was not seen (Fig. Safety and health in boatbuilding and repair. However, evidence for use of steroid injections is minimal and recommendations vary widely. https://doi.org/10.1016/j.cca.2020.09.034. Acute and chronic toxicity can occur as an occupational hazard. To prevent further GI injury, proton pump blockers should be used. Journal of Occupational Medicine and Toxicology Endoscopic evaluation is recommended within the first 24 hours of ingestion and may be beneficial up to 96 hours [19, 12]. Eller PM, Cassinelli ME. 1. Liyanage, I.K., Navinan, M.R., Pathirana, A. et al. Reversible acute kidney injury (AKI) has been reported in almost a third of published case studies. Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Van Enckevort C, Touw D, Vleming L-J. He was unaware of the level of toxicity of the substance. Authors of this case study do not have competing interests. 2011;3(6):235–44. Farrow C. Guy’s and St Thomas’ Hospital Trust. Article Copyright © 2020 Elsevier B.V. or its licensors or contributors. Gastric protection was instituted with intravenous proton pump inhibitors. doi:10.3109/15563650903478315. This could have been due to mucosal edema due to the injuries. Knowledge of MEKP dangerousness and good work practices can prevent accidental MEKP poisoning. In the absence of esophageal perforation, insertion of nasogastric tube before the onset of edema was useful in managing this patient. Methyl Ethyl Ketone (2-Butanone) 78-93-3 Hazard Summary Methyl ethyl ketone is used as a solvent. Goodman JW, Goldfarb DS, editors. This could have been due to mucosal edema due to the injuries. Environmental Chemistry com. Acute and chronic toxicity can occur as an occupational hazard. Ingestion is associated with corrosive burns leading to stricture formation, inhalational pneumonitis, acidosis, liver failure and renal failure. 2-Butanone is a manufactured chemical but it is also present in the environment from natural sources. It can cause injury to the gastrointestinal tract on ingestion, leading to gangrene or perforation. There is minimal evidence to compare continuous renal replacement therapy with conventional dialysis and both methods have been used successfully [22]. Drinking large volumes of milk or water to dilute the gastric contents has been practiced. It is a colorless liquid with a sharp, sweet odor. MEKP and MEK were successfully detected in blood samples even with less-than-ideal storage conditions. PubMed Google Scholar. Although continuing hemolysis was a possibility, coffee ground like NG aspirate and very low hemoglobin with symptoms of anemia warranted transfusions during the first weeks of treatment. 2001;57(3):203–11. Further, endoscopic intra-lesional steroid injections are postulated to augment the affects of endoscopic dilatation and may reduce further fibrosis [13, 20]. It is an organic peroxide, which is explosive in its pure form. All authors read and approved the final manuscript. Delayed fibrosis and stricture formation leading to intestinal obstruction is one of the main long-term complications of corrosive ingestion as seen in this case of MEKP poisoning. volume 10, Article number: 26 (2015) Although NAC treatment was successful, supervision after the hospitalization period was required according to the prognosis. Patnaik P. A comprehensive guide to the hazardous properties of chemical substances. One year after ingestion, he was asymptomatic and was gaining weight. Akaike T, Sato K, Ijiri S, Miyamoto Y, Kohno M, Ando M, et al. Tracheal intubation, gastric lavage and hemodialysis were not performed. 1992;294(1):55–63. John Wiley & Sons; 2007. International journal of pediatric otorhinolaryngology. However, he had persistent odynophagia. 2011;3(6):235–44. Article However there are no clinical data to support their use in acute poisoning [14]. Pediatrics. A weight gain was only noted after 9 to 12 months. In this paper we present a case of a young patient who intentionally ingested MEKP. Google Scholar. This resolved after 2 weeks and liquid feeds were gradually started as tolerated. In our patient, the follow up endoscopic examination itself cleared the inflammatory fibrotic bands producing dramatic improvement of his swallowing difficulty. Ingestion of methyl ethyl ketone peroxide is associated with a high morbidity and mortality. Cite this article. © 2020 BioMed Central Ltd unless otherwise stated. Manage cookies/Do not sell my data we use in the preference centre. Nasogastric tube contents revealed coffee ground aspirate. Encyclopedic Dictionary of Polymers. Users of these chemicals may be unaware of the potential hazards. 1985;8(3):169–82. Hemolysis settled by the second week of the illness. A loading dose of N-acetylcysteine (NAC) and subsequent maintenance doses were applied at the hospital for three consecutive days. If swallowing difficulty persists and impedes nutritional supplementation, endoscopic esophageal dilatation or esophageal resection is recommended [14]. watchbands, belts).Flush with lukewarm, gently flowing water for 5 … This is mainly attributed to rhabdomyolysis and myoglobinuria [14]. Oral administration of NAC was successful as an antidote without another approach. He had a neutrophil leukocytosis (Table 1). Bactericidal activity of alkyl peroxyl radicals generated by heme-iron-catalyzed decomposition of organic peroxides. Further, endoscopic intra-lesional steroid injections are postulated to augment the affects of endoscopic dilatation and may reduce further fibrosis [13, 20]. 1). Mittleman RE, Romig LA, Gressmann E. Suicide by ingestion of methyl ethyl ketone peroxide. The patient developed severe throat and epigastric discomfort soon after ingestion. al described the clinical features of acute intoxication in four categories. Google Scholar. Bozdemir M, Yildiz M, Seyhanlı E, Gurbuz S, Kilicaslan I, Karlidag T. Narrowing of airway caused by ingestion of methyl ethyl ketone peroxide. 2011:458-. Secondary complications include acute renal failure secondary to rhabdomyolysis, ventilator assisted pneumonia, myocarditis and acute respiratory distress syndrome [9]. The presence of stridor, odynophagia (pain on swallowing), abdominal guarding and rigidity however, indicate the presence of distal GI injuries [11]. Acute management included intravenous sodium bicarbonate to correct acidosis and medical management of hyperkalemia. Intraluminal air shadows, air in the fascial planes, pleural effusions, and gas under diaphragm are X-ray features supporting gastrointestinal perforation [18]. [3]. It is a strong oxidizing agent and a corrosive. 1). A controlled trial of corticosteroids in children with corrosive injury of the esophagus. On third day the patient developed large volume coffee ground aspirate through the NG tube, which later became bilious. Pediatrics. Van Enckevort C, Touw D, Vleming L-J. It can lead to bleeding or perforation of the GI tract which is potentially fatal [10]. By continuing you agree to the use of cookies. Severe guarding and tenderness over the epigastrium was present in examination of the abdomen. Ultrasound scan of the abdomen showed normal sized kidneys with evidence of acute renal failure.
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