Methyl ethyl ketone peroxide ingestion: Toxicity and outcome in a 6-year-old child

A 6-year-old boy developed respiratory distress, metabolic acidosis, severe esophageal and gastric burns, and a coagulopathy after ingestion of an unk nown volume of methyl ethyl ketone peroxide (MEKP) in dimethyl phthalate. H e was discharged from the pediatric intensive care unit 19 days postingesti on but subsequently developed a stricture of the gastroesophageal junction and complete fibrosis of the middle third of the stomach, necessitating gas tric resection and reconstruction. He was discharged 93 days postingestion on a program of dilation for the residual esophageal stricture. MEKP acts b y initiating lipid peroxidation via free radical production that results in cellular dysfunction and death. Acetylcysteine, a glutathione precursor an d possible free radical scavenger, may be of use in severe MEKP poisoning. This case demonstrates the severe effects that some industrial chemicals ca n have both systemically and locally at the point of contact with the gastr ointestinal tract, as well as the long-term management required to ensure g ood quality of life.