Fatal bilateral adrenal hemorrhage following acute toluene poisoning: a case report.
A 19-year-old woman was admitted to the emergency center with the development of quadriparesis after prolonged inhalation of lacquer thinner (67% toluene). Laboratory findings were compatible with a distal renal tubular acidosis manifest as metabolic acidosis, hypokalemia, and hyperchloremia. Despite potassium replacement, her condition deteriorated drastically 30 hours later. Blood pressure became refractory to vasopressors, temperature was persistently above 40 degrees C, and death occurred 56 hours later. At autopsy, adrenal insufficiency secondary to bilateral adrenal hemorrhage was diagnosed. Bilateral adrenal hemorrhage should be considered as a potential cause of sudden clinical deterioration during treatment of serious toluene intoxication.
Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan. yk119@kitasato-u.ac.jp
Y
Y
Kamijo
K
K
Soma
I
I
Hasegawa
T
T
Ohwada
D000141:Acidosis, Renal Tubular / Q000139:chemically induced; D000307:Adrenal Gland Diseases / Q000139:chemically induced* / Q000473:pathology; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D011782:Quadriplegia / Q000139:chemically induced; D019966:Substance-Related Disorders; D014050:Toluene / Q000506:poisoning*
D014050:Toluene