Two deaths after ingestion of a falsified pumpkin seed oil

Abstract

To determine the cause of death of two people who consumed a falsified pumpkin seed oil purchased online for weight loss. Medical records for both patients provided by the hospital were critical examined. The Pumpkin seed oil ingested was seized by the police and physiochemically characterized (color and odor). Also, fatty acid was analyzed by converting total fatty acids to methyl esters using n-hexane, methanolic solution of KOH and saturated solution of sodium chloride and posterior injection on GC-MS. Analytical toxicological systematic (ATS) was performed on the oil by liquid-liquid extraction with chloroform and methanol and injected on GC-MS. Diethylene glycol (DEG) was quantified by dilution with toluene and GC-FID direct injection. Biological samples (blood and urine) were collected from both victims and screened for alcohol using GC-FID headspace analysis and also for drugs, medicines and pesticides by in house ATS GC-MS and LC-MS/MS methods. DEG and diglycolic acid (DA) analysis was only performed in the victim who died 28 days after ingestion (patient A) by protein precipitation with acetonitrile and methanol and GC-MS analysis. Both patients were first admitted presenting vomiting, headache, diarrhea, fever and asthenia. Later, were transferred for the I.C.U with worsening level of consciousness, hypotension, renal failure and progressed to coma. Patient A died 28 days after hospitalization and patient B, 60 days. The pumpkin seed oil seized was colorless and odorless and any fatty acids were detectable, inconsistent with purified pumpkin seed oil or other vegetable oils. ATS in the oil was positive for glycerin and diethylene glycol. Quantitative analysis of DEG in the product presented the value of 13% v/v. Blood analysis for patient A detected trace levels of DA on patient A, DEG was not detected. The product sold as pumpkin seed oil was a falsification, did not had any vegetable oil and was contaminated with glycerin and diethylene glycol. The symptoms presented were consisted with DEG intoxication. The elimination of DEG by the body is fast, but its metabolite, diglycolic acid (DA), may persist for a long time.