Fatal Systemic Poisoning After Skin Exposure to Monochloroacetic Acid

Kulling, Per; Andersson, Hans; Boström, Kerstin; Johansson, L. A.; Lindström, Björn; Nyström, Bo

doi:10.3109/15563659209017948

Cited by 32 publications

(42 citation statements)

References 9 publications

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“…MCA has been widely used as an herbicide and an intermediate in the industrial synthesis of carboxymethylcellulose, phenoxyacetic acid, thioglycolic acid, glycine, and indigoid dyes (3). MCA is usually prepared as an 80% solution at 60°C for transport and industrial use (4).…”

Section: Introductionmentioning

confidence: 99%

Hepatic injury and gluconeogenesis after subcutaneous injection of monochloroacetic acid in rats

Toshina

Dote

Usuda

et al. 2004

Environ Health Prev Med

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Objective: Monochloroacetic acid (MCA) is corrosive to skin, and causes not only chemical injury but also fatal systemic poisoning. Little is known about the cause of death. We studied the acute toxicity of MCA before clinical symptoms appeared in fasting rats. Methods: Blood samples were analyzed 2 h after subcutaneous MCA injection (LD 90 : 162 mg/ml kg body weight). Control rats were injected with saline. Results: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were about 1.5-fold higher than in the controls, and mitochondrial AST (mAST) was 2-fold higher. Blood urea nitrogen and creatinine were significantly increased, while serum glucose was significantly decreased in the treated group. Lactate was 6-fold higher and pyruvate was 13-fold higher than in the controls. Conclusions: MCA caused injury to the liver and kidneys but these injuries were slight. However, the larger increase in mAST indicated that hepatocellular mitochondria were selectively targeted. Hepatocellular mitochondrial injury decreased gluconeogenesis and caused hypoglycemia and extremely high levels of lactate and pyruvate. Hypoglycemia and lactic acidosis were insidious before the critical symptoms appeared and this combination accelerated to death, affecting other organs such as the heart and brain. Nosotropic therapy of these abnormalities up to the appearance of symptoms may help to establish an early therapy for skin exposure to MCA.

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Section: Introductionmentioning

confidence: 99%

Hepatic injury and gluconeogenesis after subcutaneous injection of monochloroacetic acid in rats

Toshina

Dote

Usuda

et al. 2004

Environ Health Prev Med

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“…Rat studies using radiolabelled MCA showed a rapid accumulation in kidney, myocardium liver and small intestinal lumen (Kulling et al, 1992). In HUS platelet fibrin thrombi occur in capillaries, arterioles and sometimes arteries in the absence of vascular inflammation.…”

Section: Discussionmentioning

confidence: 98%

“…There have been case reports of fatal systemic poisoning following skin exposure to MCA (Kulling et al, 1992;Kush et al, 1990). Toxic manifestations have included severe metabolic acidosis, rhadomyolysis, renal failure and cerebral edema.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An Unusual Toxic Cause of Hemolytic-Uremic Syndrome

2007

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-Hemolytic uremic syndrome (HUS) has been associated with a variety of infective as well as non-infective causes. HUS as a toxic manifestation of exposure to herbicides/pesticides has not been reported so far in literature. We report a subject who presented with clinical features of features of HUS after intentional suicidal ingestion of the herbicidal agent monochloroacetic acid (MCA). A 55-yearold farmer was admitted with a history of consumption of monochloroacetic acid with vomiting, hematochezia and oligo-anuria. Our investigations revealed severe renal failure, metabolic acidosis, anemia, and thrombocytopenia with evidence of intravascular hemolysis. He was treated for HUS with plasma transfusions and haemodialysis in view of renal failure. During the course of hospital admission he developed acute antero-septal myocardial infarction and subsequently succumbed to the disease. MCA is used as an herbicidal agent and also a bleaching agent for silkworm cocoons. The toxicity of MCA has included metabolic acidosis, rhabdomyolysis and renal failure; however HUS has not been described in the literature. Extra −renal manifestations of HUS such as cardiomyopathy have also been infrequently described. This case is presented to highlight an as yet unknown toxicity of MCA.

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“…Symptoms of poisoning include agitation, cardiac failure, metabolic acidosis, renal insufficiency and cerebral edema. 54 The suspected mechanism of action is interference with the Kreb's cycle and reaction with sulfhydryl groups in enzymes. 53,54 Dichloroacetate, which is thought to reactivate the Kreb's cycle and phenobarbitone which blocks membrane processes have been suggested as a treatments for monochloroacetic acid poisoning.…”

Section: Acids and Other Chemicals That Burn Skinmentioning

confidence: 99%

Systemic toxicity from skin exposures (or what happens when you do not decontaminate)

McDougal¹,

Council²,

Powers³

2007

J. Chem. Health Saf.

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Decontamination of the skin is a process that is incompletely understood and as a result, some decontamination procedures can make penetration of a chemical through the skin worse. Therefore, it is necessary to decontaminate the skin on a rational basis, rather than indiscriminately. Systemic toxicity from skin exposures is the combined result of two chemical characteristics -penetration of the chemical through the skin and toxic potency of the chemical. The range of penetrability and toxic potency for common industrial chemicals varies over several orders of magnitude. Even an extremely toxic chemical that does not penetrate the skin readily may not need decontamination after exposure. The purpose of this review is to provide information about systemic toxicity from skin exposures and how chemical permeability and toxicity are determined, so that an individual may evaluate the necessity for decontamination of chemicals used in his/ her specific workplace.

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Fatal Systemic Poisoning After Skin Exposure to Monochloroacetic Acid

Cited by 32 publications

References 9 publications

Hepatic injury and gluconeogenesis after subcutaneous injection of monochloroacetic acid in rats

Hepatic injury and gluconeogenesis after subcutaneous injection of monochloroacetic acid in rats

An Unusual Toxic Cause of Hemolytic-Uremic Syndrome

Systemic toxicity from skin exposures (or what happens when you do not decontaminate)

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