Laryngeal edema and metabolic acidosis after Omnicide® ingestion

Abstract

Introduction. Glutaraldehyde and quaternary ammonium compounds are widely used as disinfectants and sterilizing agents. Glutaraldehyde is irritating to the eyes and upper respiratory tract, and has been associated with occupational asthma. Acute oral ingestion of a concentrated solution has not been previously reported in humans. Case Report. A 19-year-old woman presented after deliberate ingestion of a biocide containing glutaraldehyde and a quaternary ammonium compound. She developed respiratory distress and severe metabolic acidosis 10 hours after admission. Marked laryngeal edema was noted when she was being intubated. She eventually improved following supportive care and was discharged alive after 9 hospital days. Discussion. There are no reports of acute ingestions of both glutaraldehyde and quaternary ammonium compounds. As both these substances are known to cause metabolic acidosis, localized edema, erosion and sensitization of both the respiratory and alimentary tract. The clinical effect may be additive or synergistic. Conclusions. Omnicide ingestion should be closely monitored for metabolic acidosis and laryngeal edema which may progress to upper airway obstruction requiring urgent airway stabilization.

Keywords:

• Glutaraldehyde
• Metabolic acidosis
• Laryngeal oedema

Acknowledgments

We would like to thank Professors Nick Buckley, Andrew Dawson, and Kent Olson for their comments in the initial drafts. SACTRC which is funded by the Wellcome Trust/National Health and Medical Research Council International Collaborative Research Grant GR071669MA.