Fatal acute dermal and inhalational exposure

A 22 year old male arrived in hospital unconscious in impending cardiac arrest. There was a glue-like odour on his breath and his clothes were damp. He was resuscitated and ventilated. Blood gas analysis revealed acidosis. He had erythema of the face, trunk, arms and thighs. He had been painting a bathroom using a primer containing toluene 65%, acetone 20% and acrylic resin 12%. About an hour after starting he had been found unconscious in the bath with an empty can of primer beside him. It was thought that he had been overcome by the fumes, collapsed and spilt the primer over himself. The depth and extent of skin injury progressed with blistering resembling second degree burns over the neck and chest, approximately five hours after exposure the skin was irrigated. The burns covered more than 70% of the total body surface area and by the second day had worsened with extensive necrosis and massive fluid loss. The urine was dark brown, acidic (pH 5) and contained high concentrations of myoglobin. He was not oliguric but creatinine clearance was decreased. Serum creatine phosphokinase values rose from 1,170 IU/l on admission to 30,110 IU/l at 42 hours. Non-organic renal failure caused by rhabdomyolysis was diagnosed. He was started on diuresis and alkalinisation of the urine and creatinine clearance increased. Urinary concentrations of hippuric acid were 1.9, 0.5 and 0.3 g/l on the second, third and fourth days. He developed disseminated intravascular coagulation (DIC) and a prolonged prothrombin time. He suffered a cardiac arrest with subsequent brain damage and died from uncal herniation on the sixth hospital day (Shibata et al., 1994).

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