title: Dimethylformamide metabolism following self-harm using a veterinary euthanasia product.
abstract: 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.
authors.affiliation: Intensive Care, Cliniques Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium. philippe.hantson@uclouvain.be
authors.forename: Philippe
authors.initials: P
authors.lastname: Hantson
authors.forename: Antoine
authors.initials: A
authors.lastname: Villa
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Galloy
authors.forename: Sara
authors.initials: S
authors.lastname: Negri
authors.forename: Giulia
authors.initials: G
authors.lastname: Esabon
authors.forename: Fabien
authors.initials: F
authors.lastname: Lambiotte
authors.forename: Vincent
authors.initials: V
authors.lastname: Haufroid
authors.forename: Robert
authors.initials: R
authors.lastname: Garnier
mesh_terms: 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
chemical_list: D000577:Amides; D004338:Drug Combinations; D000644:Quaternary Ammonium Compounds; D013748:Tetracaine; C015591:T 61; D004126:Dimethylformamide; D000111:Acetylcysteine