Toxic benzyl alcohol inhalation: Altered mental status with metabolic acidosis and hyperammonemia

Inada, Mai; Kato, Hisaaki; Maruyama, Hirohito; Okada, Eriko; Imai, Fuminobu; Inada, Shuichi

doi:10.1016/j.ajem.2022.04.005

Cited by 4 publications

(7 citation statements)

References 7 publications

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“…Another report highlighted a case of an adult intoxicated patient with symptoms of sudden altered mental status, headache, anorexia, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia associated with renal tubular dysfunction due to inhalation exposure to benzyl alcohol. As mentioned above, the condition is currently characterized by a wide variety of symptoms [ 8 ]. In the present case, we postulated that the consciousness disorder and metabolic acidosis were induced by benzyl alcohol because the patient did not have a high body temperature when he was admitted to the previous hospital, so heatstroke could be ruled out, and there was no notable history of illness.…”

Section: Discussionmentioning

confidence: 99%

Complex poisoning mainly with benzyl alcohol complicated by paralytic ileus: a case report

et al. 2022

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Background Benzyl alcohol is used as stripping agent in paints and other applications, and benzyl alcohol poisoning is indicated by symptoms, such as impaired consciousness, respiratory depression, hypotension, metabolic acidosis, and renal dysfunction. Case presentation A 27-year-old Asian man was transported to a hospital for severe disturbance of consciousness following exposure to a paint stripper containing benzyl alcohol, ethylene glycol, and hydrogen peroxide, which he was using to repaint a bridge. The patient was treated under sedation for benzyl alcohol poisoning. On day 3 of hospitalization, his abdominal computed tomography scan revealed a paralytic ileus, so he was transferred to our hospital. The combined toxicity from multiple substances, mainly benzyl alcohol, was thought to be a contributing factor for the paralytic ileus. Upon arrival, the patient also had chemical burns, hypernatremia, and elevated myogenic enzyme levels. His urinary hippuric acid level was high (14.9 g/L) upon admission to the previous hospital. We treated the patient with artificial respiration management, while avoiding high-density oxygen, and with gastrointestinal decompression by gastric tube implantation; laxatives were also administered. The paralytic ileus improved on the 4th day, the tube was removed on the 6th day, and the patient was discharged on the 11th day of hospitalization. No apparent complications were observed at discharge. Conclusions To the best of our knowledge, this is the first case report of paralytic ileus caused by benzyl alcohol, although multiple factors may have influenced the symptoms. After exposure to benzyl alcohol by inhalation and dermal absorption, the patient developed impaired consciousness, metabolic acidosis, and paralytic ileus, and the presence of elevated urinary hippuric acid led to a definitive diagnosis.

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Section: Discussionmentioning

confidence: 99%

Complex poisoning mainly with benzyl alcohol complicated by paralytic ileus: a case report

et al. 2022

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“…Renal tubular dysfunction is considered to be a major complication, and associated symptoms are metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. [ 2 , 3 ] We could not evaluate renal tubular function and electrolyte values because the victim was already critical on admission. However, the pathological appearance of the kidney did not show degeneration of the tubular epithelium.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] There have been few case reports on benzyl alcohol intoxication in adults, and these cases showed impaired consciousness, respiratory depression, hypotension, metabolic acidosis, renal dysfunction, hypothermia, paralytic ileus, and hyperammonemia. [ 2 , 3 ] However, autopsy reports of cases of benzyl alcohol intoxication have not been published. Therefore, the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

Acute benzyl alcohol intoxication: An autopsy case report

et al. 2023

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Introduction: The main mechanism of death and the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated. Autopsy reports of cases of benzyl alcohol intoxication have not been published. Case presentation: A 24-year-old man was found in the state of cardiopulmonary arrest at a construction site. He had been performing paint stripping. He was immediately transferred to the hospital, but he did not recover. An autopsy showed focal coloring of the skin without any major caustic injury. A histopathological investigation showed vacuolar degeneration in the epidermis and dermo-epidermal junction, and severe erosion of the tracheal and bronchial mucosa. No pathological changes in the kidney were evident. A neuropathological investigation showed central chromatolysis of neuronal cells in pontine nuclei and grumose degeneration in the cerebellar dentate nucleus. The blood content of benzyl alcohol was 780.0 μg/mL. Lessons: Present case suggest that multiple pathways of exposure may be associated with more rapid progression in acute benzyl alcohol intoxication, and that early and/or severe involvement of the central nervous system rather than renal dysfunction may be associated with an early death.

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“…塗膜剥離剤は古くなった塗装（塗膜）を除去する薬剤で，橋梁など，塗装の定期的な塗り替えが必要な土木鋼構造物の塗り替え工事の際に用いられる。2018年に伊藤らが塗膜剥離剤を用いた作業中に，吸入によるベンジルアルコール中毒を来した事例を報告したが，以降，塗膜剥離工事の際に同様の事例が複数報告され，死亡事例も発生している 1), 2), 3), 4), 5)。また，この事故は夏季に発生することが多く，熱中症との関連も指摘されている 6)。今回我々は，橋梁の高架下での塗膜剥離作業中に意識障害を来して，当院に同時に搬送され，救命救急センターに入院となるが軽快し，ベンジルアルコール中毒と診断された3例を経験した。吸入による重症ベンジルアルコール中毒の経過報告は少なく，熱中症との関連も併せて考察して報告する。…”

Section: はじめにunclassified

“…また，亜急性期に高次脳機能障害を来すことが報告されている 1), 2), 3)。患者Aについて，入院中に実施した簡易知能評価スケールは満点で，画像上の異常も認めなかったが，3か月後にも記銘力障害や集中力の障害を訴えていた。また急性期に一過性の眼球運動障害や構音障害を来した。これらはベンジルアルコールの神経毒性が原因であったと推定される。神経学的異常が遷延した患者Aは初療時の意識レベルが最も悪く昏睡状態で，抜管後も不穏状態が翌日まで続き，初診時のベンジルアルコール血中濃度も高かった（84.5µg/mL）。Inadaらの報告では，曝露当日から翌日まで不穏状態を来していた患者の血中濃度は，曝露した約半日後に4.7µg/mLであった。その患者は曝露10日後まで，高次脳機能障害を来していた 3)。本症例の患者Cも来院時は同様の不穏状態であり，その後回復したが，患者B，患者Cについては，日本語での高度なコミュニケーションが困難な外国人であり，高次脳機能の評価は十分に行えておらず，軽度の障害が発生していた可能性は否定できない。…”

Section: 考　　察unclassified

暑熱環境下の塗膜剥離作業中に，同時に3名の重症ベンジルアルコール中毒が発生した事案(A case of severe benzyl alcohol intoxication of three persons simultaneously during a coating removal operation in a hot environment)

史生,

功,

恭司

et al. 2024

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨暑熱環境下におけるNE–1®（ベンジルアルコール55−65%含有）を用いた，塗膜剥離作業中に同時に3名の患者が意識障害を来し，救急搬送された。患者Aは25歳の男性。来院時のバイタルサインはGCS E1V1M1，呼吸数30/分，血圧151/91mmHg，脈拍123/分，SpO2 100%（高濃度マスク10L），体温36.2度であった。気管挿管，人工呼吸管理を実施した。患者Bは23歳の男性。バイタルサインはGCS E1V1M4，呼吸数28/分，SpO2 99%（高濃度マスク10L），ほか特記すべき異常なし。患者Bも気管挿管された。患者A，Bともに翌日には意識レベルが改善し，抜管した。患者Cは21歳の男性。バイタルサインはGCS E4V3M6，ほか特記すべき異常なし。入院後不穏状態になり，鎮静管理を要した。3名とも入院日に代謝性アシドーシスと高カリウム血症を来したが，対症療法で軽快した。その後大きな合併症なく，全員第7病日に独歩退院した。病歴，症状，尿中馬尿酸からベンジルアルコール中毒と臨床診断し，後日ベンジルアルコールの血中濃度を測定し，確定診断した。ベンジルアルコール中毒は重症化するが，特異的な治療法はなく，適切な気道確保と全身管理が重要である。またベンジルアルコールの吸入事故は暑熱環境下に発生する事例が多く，熱中症との関連についても考察した。

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Toxic benzyl alcohol inhalation: Altered mental status with metabolic acidosis and hyperammonemia

Cited by 4 publications

References 7 publications

Complex poisoning mainly with benzyl alcohol complicated by paralytic ileus: a case report

Complex poisoning mainly with benzyl alcohol complicated by paralytic ileus: a case report

Acute benzyl alcohol intoxication: An autopsy case report

暑熱環境下の塗膜剥離作業中に，同時に3名の重症ベンジルアルコール中毒が発生した事案(A case of severe benzyl alcohol intoxication of three persons simultaneously during a coating removal operation in a hot environment)

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