Dimethylformamide metabolism following self-harm using a veterinary euthanasia product.
BACKGROUND
A veterinary euthanasia drug containing embutramide, mebezonium, tetracaine, and dimethylformamide (DMF; T-61® or Tanax®) may cause serious manifestations or even fatalities after self-poisoning. Immediate toxicity is mainly due to a general anesthetic and due to a neuromuscular blocking agent, while delayed hepatotoxicity seems related to the solvent DMF. The protective role of N-acetylcysteine (NAC) administration remains debatable.


METHODS
Two male veterinarians (50- and 44-year-old) attempted suicide by injecting T-61 in the precordial area for the first one, and by ingesting 50 mL for the second. Both received NAC (for 14 days in the first case and only for 20 h in the second). Urine was collected for the serial determination of DMF, N-methylformamide (NMF), and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC).


RESULTS
Both patients developed only mild signs of liver injury. The metabolite of DMF, NMF, appeared rapidly in the urine, while a further delay was necessary for AMCC excretion. The kinetics of elimination of DMF and DMF metabolites were slightly slower than those reported in exposed workers.


CONCLUSIONS
While both patients had a favorable outcome, there is no clear evidence that NAC could directly influence NMF and AMCC excretion. Further investigations of NMF and AMCC excretion, with and without NAC, would be indicated.
Hantson
Philippe
P
Intensive Care, Cliniques Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium. philippe.hantson@uclouvain.be
Villa
Antoine
A
Galloy
Anne-Cécile
AC
Negri
Sara
S
Esabon
Giulia
G
Lambiotte
Fabien
F
Haufroid
Vincent
V
Garnier
Robert
R
D000111:Acetylcysteine / Q000627:therapeutic use; D000577:Amides / Q000506:poisoning*; D004126:Dimethylformamide / Q000378:metabolism*; D004338:Drug Combinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D000644:Quaternary Ammonium Compounds / Q000506:poisoning*; D013405:Suicide; D013748:Tetracaine / Q000506:poisoning*; D018634:Veterinarians
D000577:Amides; D004338:Drug Combinations; D000644:Quaternary Ammonium Compounds; D013748:Tetracaine; C015591:T 61; D004126:Dimethylformamide; D000111:Acetylcysteine