O42: Two case-reports of intoxication with T61®, a mixture used in veterinary medecine

Abstract

T61® is a mixture of three compounds (embutramide 200 mg/ml, mebezonium iodide 50 mg/ml and tetracaine 5 mg/ml) solubilised in N, N-dimethylformamide and commonly used for euthanasia of animals because of its narcotic and curariform-like activities. Unfortunately, T61® has been also involved in suicide or suicide attempts. A mother, veterinary assistant, injected T61® by intravenous route to her 7-year old child, together with ketamine (Clorketam®). She also explained that then she administered by herself T61® by oral and/or intramuscular route(s). A neighbour found the mother into status of epilepticus and the child presenting a cardiac-respiratory arrest. They were admitted to the emergency department of Angers's hospital 6-hours later and blood samples were collected. Chromatographic analyses (LC-UV/DAD and GC-MS) were performed on blood samples and a liquid contained in the bottle found near the bodies. Plasma embutramide concentrations were 2,5 mg/L for the mother and 5,0 mg/L for the child. Ketamine and norketamine were also found, in the blood of the child at 0.55 and 0,9 mg/L, respectively. The liquid contained embutramide (160 mg/L) and tetracaine, which is consistent with the hypothesis of using T61®, even if mebezonium was not visible with our method. On the admission, the child presented a cerebral oedema, bilateral papillary mydriasis fixed to light, lactic acidosis, then she was brain dead 10h later. The mother waked out from the coma and the administration of N-acetylcysteine was continued to counteract the hepatic side effects of N, N-dimethylformamide as she presented cytolytic hepatits (PT of 29%) 3 days after her admission. Eight fatal case-reports were described, mainly after intravenous injection of T61® (or Tanax®) and the postmortem blood concentrations of embutramide were ranging from 3 to 90 mg/L. Our case-report was the first described for a child, with a concentration of 5 mg/L. The simultaneous presence of ketamine and embutramide associated with mebezonium could have contributed to her death. The mother survived probably because she would have administered T61® by extravascular route, hence lowering the drug exposition.