title: Fatal bromethalin poisoning.
abstract: Bromethalin is a neurotoxin found in some rodenticides. A delusional 21-year-old male presented to a hospital with altered mental status the day after ingesting a bromethalin-based rodenticide. He died 7 days after his self-reported exposure to c. 17 mg bromethalin (equivalent to 0.33 mg bromethalin/kg). His clinicopathologic course was characterized by altered mental status, obtundation, increased cerebrospinal fluid pressure, cerebral edema, death, and diffuse histologic vacuolization of the white matter in the central nervous system seen on microscopic examination at autopsy. The presence of a demethylated form of bromethalin in the patient's liver and brain was confirmed by gas chromatography with mass spectrometry. Clinical signs and lesions observed in this patient are similar to those seen in animals poisoned with bromethalin. This case illustrates the potential for bromethalin ingestion to result in fatal human poisoning.
authors.affiliation: Office of the Chief Medical Examiner, 520 First Avenue, New York, NY 10016, USA. pasqualemd@hotmail.com
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pasquale-Styles
authors.forename: Mark A
authors.initials: MA
authors.lastname: Sochaski
authors.forename: David C
authors.initials: DC
authors.lastname: Dorman
authors.forename: Willane S
authors.initials: WS
authors.lastname: Krell
authors.forename: Aashit K
authors.initials: AK
authors.lastname: Shah
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000814:Aniline Compounds / Q000032:analysis / Q000506:poisoning*; D001923:Brain Chemistry; D006801:Humans; D008099:Liver / Q000737:chemistry; D008297:Male; D009498:Neurotoxins / Q000032:analysis / Q000506:poisoning*; D012378:Rodenticides / Q000737:chemistry; D014617:Vacuoles
chemical_list: D000814:Aniline Compounds; D009498:Neurotoxins; D012378:Rodenticides; C040307:bromethalin