Diverse manifestations of oral methylene chloride poisoning: Report of 6 cases

Objective: Methylene chloride is a solvent used in domestic and industrial preparations, such as paint removers and degreasing agents. Although it is considered of low toxicity, acute toxic manifestations have been reported f ollowing inhalation of methylene chloride, mainly from working in an enclos ed environment. Oral ingestion of methylene chloride, however, remains:rare ana its consequences are less clearly understood, Case Reports: The variou s clinical manifestations of 6 patients with oral ingestion of methylene ch loride are reported. Central nervous system depression, tachypnea, and corr osive;gastrointestinal injury were the most common presentations following ingestion, An elevated carboxyhemoglobin level was documented in only 2 pat ients (35% and 8.4% carboxyhemoglobin, respectively), Due to a frequent mis leading history;of "chloroform" ingestion and unawareness of probable carbo xyhemoglobin production in these patients, carboxyhemoglobin was not routin ely measured. Renal failure, hepatic failure, and acute pancreatitis occurr ed in the 2 most severe cases of methylene chloride ingestion, Conclusions: ingestion of methylene chloride can result in diverse manifestations, incl uding a high carboxyhemoglobin level. Corrosive gastrointestinal injury is common in oral poisoning and needs further therapeutic consideration. A hig h index of suspicion and appropriate laboratory studies are needed in those patients who allegedly ingest "chloroform" but do not present the incrimin ating solvent to their treating physicians, The presence of an elevated car boxyhemoglobin level suggests the diagnosis of methylene chloride poisoning . Symptomatic and supportive measures remain the mainstay in the treatment of patients with oral methylene chloride poisoning.