US EPA

1227401 

Journal Article 

A Case of Acute Intentional Ethyl Acetate Ingestion with Severe Metabolic Acidosis 

Verstegen, G; Claus, M; Van Pelt, H; Mostin, M 

2008 

1 

Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 

46 

5 (Jun 2008) 

415. 

Objective: Ethyl acetate is generally considered of limited toxicity. We aim to describe a near fatal poisoning after ingestion of approximately 80 grams of ethyl acetate. Case report: A 78-year-old woman intentionally ingested 100 ml of nail polish remover containing 85% ethyl acetate and minor percentages of methylpyrollidone, dimethylsuccinate, dimethylglutarate and dimethyladipate. On admittance, one hour later, she presented in cardiovascular shock with pronounced bradycardia (25 beats/minute) and blood pressure of 45/30 mm Hg. Blood gas results under 40% FiO sub(2) were pH 6.39, pCO sub(2) 25 mm Hg, PO sub(2) 440 mm Hg, bicarbonate 6 mEq/L and a anion gap of 45 mEq/L. Serum ethanol was 1.2 g/L, methanol 0.15 g/l and osmolality 352 mOsm/kg. The patient was intubated, transferred to the ICU and hemodialysis was started for 3 hours. After dialysis arterial pH was 7.40, bicarbonate 23 mEq/l with an anion gap of 29 mEq/l. On day 2, a marked toxic hepatic injury became apparent (aspartate aminotransferase 6339 U/L, alanine aminotransferase ALT 3733 U/L). Lactate normalised on day 4 but there was persistent hemodynamic instability. She was extubated on day 8, transferred to a medical ward on day 11 and recovered without sequelae. Discussion: Little is known about human toxicity of ethyl acetate. From animal data it is known that it is easily absorbed orally and can be hydrol-ysed by liver and plasma esterases into ethanol and acetic acid (1). Based on the clinical course, ethyl acetate was apparently rapidly absorbed and readily hydrolysed with a pronounced acidosis accompanied by cardiovascular shock. There was severe toxic hepatic injury which has been described in animals (1) but not in humans. In the literature we found one report of fatal ethyl acetate poisoning (2). The low ratios of ethyl acetate to ethanol in post mortem tissue samples confirmed the rapid biotransformation of ethyl acetate which fits with our observations. Conclusion: Ingestion of small amounts of nail polish removers containing ethyl acetate is a common accident and is usually considered not toxic. However, if ingested in large amounts it can lead to rapid and massive release of acetic acid with a life threatening acidosis and hepatocellular damage. 

Aspartate aminotransferase; Hemodynamics; Anions; Injuries; Blood pressure; Acidosis; Methanol; Complications; esterase; Bicarbonate; Ethyl acetate; Lactic acid; Hemodialysis; Alanine transaminase; Carcinoembryonic antigen; Liver; Ethanol; Case reports; Acetic acid; pH effects; Accidents; Metabolic acidosis; Shock; biotransformation; Poisoning; Toxicity; Bradycardia