Fatal large-volume mouthwash ingestion in an adult: a review and the possible role of phenolic compound toxicity.
OBJECTIVE
To describe a case of fatal mouthwash ingestion and review possible sources of toxicity.


METHODS
Case report.


METHODS
Veterans Administration Medical Center.


METHODS
Single patient with massive mouthwash ingestion.


RESULTS
This patient was a 45-year-old man who developed cardiovascular collapse and multiorgan system failure following a massive ingestion of mouthwash (almost 3 liters). His presentation was remarkable for a profound anion-gap metabolic acidosis and a significant osmolar gap. No other co-ingestants were identified, and he expired despite full supportive care including dialysis and mechanical ventilation. An autopsy failed to identify any other cause of death. Nonalcoholic ingredients of this mouthwash are phenolic compounds (eucalyptol, menthol, and thymol), and large-volume mouthwash ingestion will produce exposure in the reported toxic range of these ingredients.


CONCLUSIONS
When ingested in large quantities, the phenolic compounds in mouthwash may contribute to a severe anion-gap metabolic acidosis and osmolar gap, multiorgan system failure, and death. These compounds, in addition to alcohol, may account for the adverse effects associated with massive mouthwash ingestion.
Soo Hoo
Guy W
GW
Pulmonary and Critical Care Section, VA Greater Los Angeles Healthcare System, UCLA School of Medicine 90073, USA. guy.soohoo@med.va.gov
Hinds
Robert L
RL
Dinovo
Eugene
E
Renner
Stephen W
SW
D000138:Acidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000437:Alcoholism / Q000150:complications; D000891:Anti-Infective Agents, Local / Q000506:poisoning; D001344:Autopsy; D002423:Cause of Death; D003422:Critical Care / Q000379:methods; D004338:Drug Combinations; D062787:Drug Overdose; D005052:Eucalyptus / Q000506:poisoning; D017809:Fatal Outcome; D005404:Fixatives / Q000506:poisoning; D006801:Humans; D008297:Male; D008610:Menthol / Q000506:poisoning; D008875:Middle Aged; D009067:Mouthwashes / Q000737:chemistry / Q000506:poisoning*; D009102:Multiple Organ Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010636:Phenols / Q000506:poisoning*; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012307:Risk Factors; D012459:Salicylates / Q000737:chemistry / Q000506:poisoning*; D012720:Severity of Illness Index; D013729:Terpenes / Q000737:chemistry / Q000506:poisoning*; D013943:Thymol / Q000506:poisoning
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D005404:Fixatives; D009067:Mouthwashes; D010636:Phenols; D012459:Salicylates; D013729:Terpenes; D008610:Menthol; D013943:Thymol; C057473:Listerine; C033069:methyl salicylate