Toluene Poisoning (Accidental Ingestion of Evostik)

Abstract

Introduction: Childhood poisoning is one of the causes of high morbidity and mortality especially among under-five children in low income  countries. The home and its surroundings may harbour poisonous substances which might be ingested by adventurous children. Evo-stik glue is a modified silane (MS) polymer based high performance adhesive. It contains toluene, a colourless, sweet-smelling liquid with detrimental effects on virtually every organ in the body especially brain and kidneys. Toluene is a component of household items such as gasoline, shoe and nail polish.
Aim / Objectives: From a few reported cases of toluene poisoning worldwide there was need to create awareness on the possibility of toluene poisoning as well as its deleterious effects. This is a case report on exposure to the effects of toluene by accidental ingestion that set the platform to
emphasize the importance of prompt and appropriate management of toluene poisoning.
Methodology: This case report is about a 2year old girl who accidentally ingested 15-20ml evostik glue stored in an attractive container in the  home. QH was presented at the Lagos State University Teaching Hospital Paediatric Emergency Unit with a one day history of persistent  spontaneous, non-projectile and non-bilous vomiting. On admission, she was conscious, moderately dehydrated with dry buccal mucosa. (38.2ºC)
febrile, but not pale, icteric, or cyanosed. She developed seizures, recurrent hypoglycaemia, generalized peripheral edema and Anurias. On the second day of admission a renal challenge was performed to which the kidneys were unresponsive. Intravenous fluid was then restricted in line with conservative management of acute kidney injury when renal challenge fails. Deranged electrolytes and hypoglycaemia were corrected. She was also placed on an antihypertensive (Amlodipine). In addition, she received intravenous Omeprazole and Ranitidine on account of upper gastrointestinal bleeding. Haemodialysis and upper gastrointestinal endoscopy could however not be done on the second day of admission due to logistic reasons.
On the third day she slipped into unconsciousness and her Glasgow coma scale had dropped to 8/15. A double volume exchange blood transfusion was commenced. The patient’s clinical state suddenly deteriorated during the procedure and she succumbed despite all efforts at resuscitation.
Results: She developed persistent vomiting, altered sensorium and acute kidney injury within 48 hours of presentation. The case was 100% fatal. Toluene significantly inhibits the N-Methyl-D aspartic acid (NMDA) subtype of glutamate-activated ion channel. It remarkably reduces metabolic
function in the brain increases dopamine release and the activity of dopaminergic neurons.
Conclusion: Toluene poisoning is associated with high mortality. Early presentation and prompt intervention may lead to a good outcome.  Prevention of accidental ingestion of toxic substances at home is key in averting mortality associated with childhood poisoning.

Keywords: Toluene Poisoning, Evostik, Nigerian