Volume 7, Issue 3 (2021)                   Pharm Biomed Res 2021, 7(3): 217-220 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mohammadzadeh H, Mohammadi H, Tavakoli M A, Sadeghi S. Sudden Death Due to Acetone Toxicity. Pharm Biomed Res. 2021; 7 (3) :217-220
URL: http://pbr.mazums.ac.ir/article-1-348-en.html
1- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
2- Pharmaceutical Science Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Full-Text [PDF 2887 kb]   (244 Downloads)     |   Abstract (HTML)  (3660 Views)
Full-Text:   (238 Views)
Introduction
Acetone or propanone is a volatile liquid, i.e., absorbed by ingestion, inhalation, and dermal, and distributed throughout the body [1, 2]. Acetone is a solvent abused in “sniffing glue” [3]. Acetone is used as a solvent for paints, adhesives, and plastics; it is endogenously produced during fasting or diabetic ketoacidosis [4]. Forensic toxicologists usually encounter high levels of acetone in body fluids whenever individuals ingest isopropyl alcohol for intoxication purposes, as ketones are metabolites of secondary alcohols [5]. 

Case Presentation
This study reported the case of a 25-year-old unmarried male nurse with a history of smoking over the last 4 years as well as diarrhea and nausea on the day before death. The deceased worked in the Emergency Medical Center of North Khorasan Province, Iran, and his body was found there 4 hours after death. According to interviews with his colleagues and family, he had no history of depression. A postmortem examination was performed to define the cause of death. In the autopsy, severe pulmonary congestion was reported. Besides, the heart was unremarkable. 
Postmortem quantitative toxicological analysis signified acetone in the vitreous (35 mg/dL), blood (28 mg/dL), and urine (77 mg/dL) samples. No isopropanol, drugs, opioids, carbon monoxide, or phosphides were detected in the bile, kidney, liver, or stomach contents. Postmortem pathology examination highlighted diffuse congestion, mild atherosclerotic changes in the coronary arteries, congestion in the lung, pulmonary hemorrhage, highly microvascular changes (Figures 1), the diffuse necrosis of hepatocytes, and the infiltration of inflammatory cells in the liver and brain vascular hyperemia.

He was poisoned with acetone and had no other definite medical problems. There was no evidence that how s the amount of liquid was consumed by him. It also remained undiscovered whether it was solvent abuse, suicide, or accidental occupational exposure at work. The cause of death was determined to be acute acetone intoxication. 

Discussion
The toxicity of acetone is the same as ethanol; although the anesthetic potency of acetone is much greater [6, 7]. Acetone-associated Central Nerves System (CNS) depression can range from mild lethargy with ataxia and slurred speech to deep coma [7]. Rarely, the massive ingestion of acetone results in hypotension, respiratory arrest, and negative cardiac inotropic effects [7]. The 1991 Annual Report of the American Association of Poison Control Centers (AAPCC) National Data Collection System documented 1137 incidents of human exposure to acetone without fatalities [8]. The clearance of acetone is slow and recovery from acetone narcosis does not occur for at least 9 hours post-exposure [9]. The excretion of acetone occurs via the urine and breath, especially the breath [1, 6, 10]. Acetone is metabolized to methanolic and ethanoic acids, which induce mild acidosis [9]. Severe toxic effects of Acetone are associated with blood levels of 20-30 mg/dl, and a blood level of 55 mg/dL was detected in fatal cases [3]. The high concentration of acetone in the human samples was observed after the direct ingestion of acetone and isopropanol metabolized to acetone in patients with diabetes [5, 10]. In diabetic ketoacidosis, the range of acetone concentrations almost equals 10-70 mg/dL [10]. Therefore, contrary to public opinion, acetone is a toxic and dangerous substance; it is necessary to improve and implement public safeguards concerning acetone usage, as well as its handling and disposal. Organ toxicity due to acetone can be a major cause of death. Other alcohol-related poisoning deaths, like acetone, should be considered.

Conclusion 
This report highlighted rare sudden death due to solvents poisoning. Contrary to public opinion, acetone is a toxic and dangerous substance; thus, it is necessary to improve and implement public safeguards concerning acetone usage, as well as its handling, and disposal.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were considered in this article. The study protocol was in conformity with the ethical guidelines of the 1975 Declaration of Helsinki, revised in 1983. The authors confirm that an informed consent was obtained from the legal relatives of the decedent prior to drafting this report. Private information, including name and surname was removed from the data sheet to comply with ethical concerns.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article. 

Conflict of interest
The authors declared no conflict of interest.


Acknowledgments
We would like to thank the staff of North Khorasan Legal Medicine Center for their kind cooperation.


References
  1. Kalapos Mp. Acetone. In: Wexler P, Anderson BD, editors. Encyclopedia of toxicology. Amsterdam: Elsevier Science; 2014. pp. 36-9. [DOI:10.1016/B978-0-12-386454-3.00995-7]
  2. Bradberry S. Acetone. Medicine. 2007; 35(11):581. [DOI:10.1016/j.mpmed.2007.08.012]
  3. Moffat AC, Osselton MD, Widdop B, Watts J. Clarke’s analysis of drugs and poisons in. London: Pharmaceutical Press; 2011. https://d1wqtxts1xzle7.cloudfront.net/46135452/DeWolff_DeWolff_Natural_Toxins_Clarke_2011
  4. Jenkins AJ, Merrick TC, Oblock JM. Evaluation of isopropanol concentrations in the presence of acetone in postmortem biological fluids. J Anal Toxicol. 2008; 32(8):719-20. [DOI:10.1093/jat/32.8.719] [PMID]
  5. Jones AW. Elimination half-life of acetone in humans: Case reports and review of the literature. J Anal Toxicol. 2000; 24(1):8-10. [DOI:10.1093/jat/24.1.8] [PMID]
  6. Kumarvel V, Da Fonseca J. Acetone poisoning-a diagnostic dilemma. Eur J Anaesthesiol. 2007; 24(9):805-6. [DOI:10.1017/S0265021507000245] [PMID]
  7. Shannon MW, Borron SW, Burns M. Haddad and Winchester’s clinical management of poisoning and drug overdose. philadelphia: Saunders Elsevier; 2007. https://www.google.com/books/edition/Haddad_and_Winchester_s_Clinical_Managem/3jp3AAAACAAJ?hl=en
  8. Hansen H, Wilbur SB. Toxicological profile for acetone. Atlanta: Department of Health and Human Services Public Health Service Agency for Toxic Substances and Disease Registry; 1994.
  9. Klaassen CD. Casarett and Doull’s toxicology: The basic science of poisons. 9th ed.: Pergamon Press; 2019. https://accesspharmacy.mhmedical.com/book.aspx?bookID=2462#194918150
  10. Ramu A, Rosenbaum J, Blaschke TF. Disposition of acetone following acute acetone intoxication. West J Med. 1978; 129(5):429-32. [PMID]
Type of Study: case report | Subject: Toxicology

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2022 CC BY-NC 4.0 | Pharmaceutical and Biomedical Research

Designed & Developed by : Yektaweb