title: Chloroform ingestion causing severe gastrointestinal injury, hepatotoxicity and dermatitis confirmed with plasma chloroform concentrations.
abstract: BACKGROUND
  Poisoning due to chloroform ingestion is rare. The classic features of acute chloroform toxicity include central nervous system (CNS) and respiratory depression, and delayed hepatotoxicity.
  
  
  METHODS
  A 30-year-old female ingested 20-30 mL of 99% chloroform solution, which caused rapid loss of consciousness, transient hypotension and severe respiratory depression requiring endotracheal intubation and ventilation. She was alert by 12 h and extubated 16 h post-overdose. At 38-h post-ingestion, her liver function tests started to rise and she was commenced on intravenous acetylcysteine. Her alanine transaminase (1283 U/L), aspartate transaminase (734 U/L) and international normalized ratio (2.3) peaked 67- to 72-h post-ingestion. She also developed severe abdominal pain, vomiting and diarrhoea. An abdominal CT scan was consistent with severe enterocolitis, and an upper gastrointestinal endoscopy showed erosive oesophagitis, severe erosive gastritis and ulceration. She was treated with opioid analgesia, proton pump inhibitors, sucralfate and total parenteral nutrition. Secretions caused a contact dermatitis of her face and back. Nine days post-ingestion she was able to tolerate food. Her liver function tests normalized and the dermatitis resolved. Chloroform was measured using headspace gas chromatograph mass spectrometry, with a peak concentration of 2.00 μg/mL, 4 h 20 min post-ingestion. The concentration-time data fitted a 1-compartment model with elimination half-life 6.5 h.
  
  
  CONCLUSIONS
  In addition to early CNS depression and delayed hepatotoxicity, we report severe gastrointestinal injury and dermatitis with chloroform ingestion. Recovery occurred with good supportive care, acetylcysteine and management of gastrointestinal complications.
authors: a Department of Clinical Pharmacology & Toxicology , Western Sydney Health , Sydney , Australia.
authors: Dushan
authors: D
authors: Jayaweera
authors: a Department of Clinical Pharmacology & Toxicology , Western Sydney Health , Sydney , Australia.
authors: Shawkat
authors: S
authors: Islam
authors: a Department of Clinical Pharmacology & Toxicology , Western Sydney Health , Sydney , Australia.
authors: Naren
authors: N
authors: Gunja
authors: b Shimadzu Australasia , Sydney , Australia.
authors: Chris
authors: C
authors: Cowie
authors: b Shimadzu Australasia , Sydney , Australia.
authors: James
authors: J
authors: Broska
authors: c Intensive Care Unit , Blacktown Hospital , Sydney , Australia.
authors: Latesh
authors: L
authors: Poojara
authors: d Therapeutics Research Centre, University of Queensland , Brisbane , Australia.|e School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , Australia.
authors: Michael S
authors: MS
authors: Roberts
authors: f Clinical Toxicology Research Group , University of Newcastle , Newcastle , Australia.
authors: Geoffrey K
authors: GK
authors: Isbister
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000111:Acetylcysteine / Q000627:therapeutic use; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002725:Chloroform / Q000493:pharmacokinetics / Q000506:poisoning*; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D062787:Drug Overdose; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D006207:Half-Life; D006801:Humans; D008111:Liver Function Tests; D008954:Models, Biological; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy
chemical_list: D000931:Antidotes; D002725:Chloroform; D000111:Acetylcysteine
keywords: Chloroform; acetylcysteine; dermatitis; enterocolitis; hepatotoxicity; toxicity