Abstract
BackgroundBrake fluid is used for automobiles. It is a mixture of different glycol derivatives including ethylene glycol and diethylene glycol (DEG) which are metabolized into various toxic metabolites. Fatalities following brake fluid ingestion are rare in forensic practice. Here, we report a case of suicide by brake fluid ingestion complicated with severe renal failure and esophageal and gastric erosions.Case presentationA 52-year-old male, with a history of alcohol dependence and comorbid moderate depression, ingested a bottle of brake fluid (100ml) mixed with alcohol. He had defaulted psychiatric follow-up. He developed severe metabolic acidosis and acute renal failure which necessitated intensive care, other supportive management, and the antidote; ethyl alcohol. On the 2nd day of admission, he developed upper gastrointestinal bleeding with melena. He also had seizures and cardiovascular complications. He died 12 days after hospital admission, and the manner of death was concluded as suicidal. The autopsy revealed congested and edematous brain, flabby and pale heart without evidence of infarction, erythematous trachea, bilateral diffuse pulmonary edema, congested liver, ulcer over the lower 1/3 of the esophagus, and few ulcers in the stomach. Also, the kidneys were edematous, diffusely necrosed, and there were adrenal hemorrhages.ConclusionsThis case report highlights the severity of effects of brake fluid poisoning including the corrosive effect on gastrointestinal mucosa which is rarely encountered in clinical practice.
Highlights
This case report highlights the severity of effects of brake fluid poisoning including the corrosive effect on gastrointestinal mucosa which is rarely encountered in clinical practice
➢ Different methods are applied for suicide, especially firearms, agrochemicals, etc. ➢ Self-poisoning with brake oil is rare, and fatality is a remote possibility. ➢ Ethylene glycol, diethylene glycol (DEG), and its metabolites are responsible for the toxicity. ➢ Clinical outcomes of ethylene glycol toxicity and DEG toxicity differ from each other which can be attributed to its different pathways of metabolism
On day 2 of admission, he developed upper gastrointestinal bleeding with melena. He was shifted from ward to high dependency unit (HDU) and to the intensive care unit (ICU) where he was electively intubated and started on hemodialysis
Summary
➢ Different methods are applied for suicide, especially firearms, agrochemicals, etc. ➢ Self-poisoning with brake oil is rare, and fatality is a remote possibility. ➢ Ethylene glycol, DEG, and its metabolites are responsible for the toxicity. ➢ Clinical outcomes of ethylene glycol toxicity and DEG toxicity differ from each other which can be attributed to its different pathways of metabolism. ➢ Different methods are applied for suicide, especially firearms, agrochemicals, etc. ➢ Self-poisoning with brake oil is rare, and fatality is a remote possibility. ➢ Ethylene glycol, DEG, and its metabolites are responsible for the toxicity. ➢ Clinical outcomes of ethylene glycol toxicity and DEG toxicity differ from each other which can be attributed to its different pathways of metabolism. ➢ The presented case highlights the systemic effects and pathological changes of fatal brake oil poisoning
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