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

Figures & data

Table 1. Review of literature

Reference	year of publication	Age (yrs)	Amount hardener (ml)	MEKP (%)	Time lag (min) ##	Upper GI tract injury	Injury to other organs	Treatment	Fatal outcome ###	Residual symptoms
4	‘58	34	60	60	15	yes	no	rehydration vitamin B	no	oesophageal stenosis
								oesophageal dilatation
5	‘62	57	?	60	?	yes	aspiration pneumonitis	milk	no	no
							toxic myocarditis	antacids
								steroids
								antibiotics
6	‘71	46	50	60	<15	yes	pneumonia with sepsis	gastric lavage	yes	no
							acute renal failure	antacids
							hepatic necrosis	hydrocortisone
								antibiotics
								peritoneal dialysis
7#	‘79	?	?	?	?	yes	psychomotor stimulation	unknown	2 / 13	unknown
8	‘86	1,6	?	?	?	yes	No	unknown	no	no
8	‘86	41	?	50	<15	yes	pharyngitis	mechanical	yes	no
							hepatic necrosis	ventilation
								bicarbonate
								solumedrol
								mannitol
								H2-blocker
								antibiotics
								inotropics
								surgery
8	‘86	55	?	?	?	?	Unknown	unknown	yes	no
9	‘90	47	50–100	40–60	30	yes	cardiac arrest	bicarbonate	yes	no
							sepsis	furosemide
							respiratory failure	mannitol
							renal failure	dialysis
							hepatic coma rhabdomyolysis
10/11	‘91/‘92	46	?	< 50	<15	yes	Liver function abnormalities	parenteral feeding	no	gastric ulcera after 3 months
12	‘97	3	40	?	45	yes	Neurological depression	antibiotics	no	oesophageal stenosis
								vitamin K
								H2-blocker
								gastric washout
								oesophageal dilatation
13	‘01	6	?	?	450	yes	Respiratory distress	antibiotics	no	oesophageal stenosis
							Metabolic acidosis coagulopathy	enteral feeding
								partial gastric resection

^#Ref. 4 describes 13 cases.

^##Time lag is the time period between ingestion and the moment when medical attention was first received.

^###Cause of death was confirmed by autopsy in articles 6, 8, and 9. In article 7, one case was confirmed by autopsy and one case by toxicology.

Table 2. Laboratory results

Result (normal range)	Day 1 10:52 am	02:42 pm	10:11 pm	Day 2 08:00 am	Day 3 08:00 am	Day 4 08:00 am
Leucocytes (4–11 10*9/l)	11.7			19.0	12.0	7.9
PTT (8.5–11.5 sec)	11.8			13.8	12.4	11.4
Amylase (50–220 U/l)	284			274	177
ASAT (<40 U/l)	24			16	12
ALAT (<45 U/l)	22			12	14
GGT (<35 U/l)	20			12	13
Alk. Phos (40–120 U/l)	113			69	57
Bilirubine (5–19 μmol/l)	24			17
Glucose (3.5–5.5 mmol/l)	10.5			10.6	7.7
Creatinine (64–115 μmol/l)	128			103	84	91
PH (7.37–7.43)	7.41	7.27	7.37	7.37	7.44
Bicarbonate (22–27 mmol/l)	21.5	17.4	21.7	21.4	28.0
Osmolar gap (mosm/kg)	5	8	0
Methyl ethyl ketone (mg/l)	3			0	0	0
Acetic acid (mg/l)	80			15	7	0

Fig. 1.  Image during oesophagogastroduodenoscopy showing the antral region of the stomach with inflammation and necrotic lesions of the mucosal surfaces with ulceration.

Table 3. Schedule for acetaminophen-poisoning

Bolus I.V:	150 mg/kg N-acetylcysteine in a 5% glucose solution in 15 min
Continuous I.V:	50 mg/kg N-acetylcysteine in a 5% glucose solution in 8 hrs