title: An autopsy case of fatal repellent air freshener poisoning.
abstract: We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1h after the collapse, he was in cardiopulmonary arrest and subsequently died 10h after his arrival. The forensic autopsy performed 5.5h after death revealed the 380ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1μg/ml and 558.2μg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household.
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Japan. Electronic address: hitosugi@belle.shiga-med.ac.jp.
authors.forename: Masahito
authors.initials: M
authors.lastname: Hitosugi
authors.affiliation: Department of Legal Medicine, Dokkyo Medical University School of Medicine, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Tsukada
authors.affiliation: Department of Legal Medicine, Dokkyo Medical University School of Medicine, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Yamauchi
authors.affiliation: Forensic Science Laboratory, Tochigi Prefectural Police Headquarters, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furukawa
authors.affiliation: Department of Legal Medicine, Shiga University of Medical Science, Japan.
authors.forename: Satomu
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Legal Medicine, Dokkyo Medical University School of Medicine, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nagai
mesh_terms: D000336:Aerosols / Q000506:poisoning*; D000368:Aged; D001344:Autopsy; D002368:Castor Oil / Q000031:analogs & derivatives / Q000506:poisoning; D017809:Fatal Outcome; D006323:Heart Arrest / Q000139:chemically induced; D006795:Household Products / Q000506:poisoning*; D006801:Humans; D008297:Male; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000506:poisoning; D013501:Surface-Active Agents / Q000506:poisoning; D055549:Volatile Organic Compounds / Q000506:poisoning
chemical_list: D000336:Aerosols; D013501:Surface-Active Agents; D055549:Volatile Organic Compounds; D000077423:Polidocanol; D011092:Polyethylene Glycols; C023040:polyethoxylated castor oil; D002368:Castor Oil
keywords: Autopsy; Death; Poisoning; Repellent air freshener; Surfactant