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Lethal poisoning with ethiofencarb and ethanol.

Muhammad S J Al-Samarraie¹, Ritva Karinen, Torleiv Rognum

¹Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Oslo, Norway. Muhammad.Al-Samarraie@fhi.no

Journal of Analytical Toxicology

|October 3, 2009

Summary

This case report details a fatal ethiofencarb poisoning, presenting the first quantitative analysis of ethiofencarb and its metabolites in human postmortem blood. The findings highlight the potential for severe toxicity from this carbamate insecticide.

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Area of Science:

Toxicology
Forensic Science
Environmental Health

Background:

Ethiofencarb, a carbamate insecticide, is generally considered less toxic than organophosphates due to reversible acetylcholinesterase inhibition.
Despite its classification as low toxicity (LD(50) > 200 mg/kg), severe poisoning and fatalities can occur.
There is a lack of published data on ethiofencarb and metabolite levels in human postmortem blood.

Observation:

A 56-year-old male gardener presented with symptoms of severe poisoning, including vomiting and pulmonary edema, following suspected ethiofencarb exposure.
Despite medical intervention, the patient's condition rapidly deteriorated, leading to death approximately 3 hours after hospital admission.
The case involved co-ingestion of ethanol, complicating the clinical picture and toxicological analysis.

Findings:

Quantitative analysis of postmortem peripheral blood revealed significant levels of ethiofencarb (26.4 mg/L), ethiofencarbsulfoxide (37.9 mg/L), and ethiofencarbsulfone (0.9 mg/L).
Ethanol was also detected in postmortem blood (0.12 g/100 mL) and urine.
Ethiofencarb and its metabolites were identified in postmortem urine samples, confirming systemic absorption and excretion.

Implications:

This study provides crucial quantitative data on ethiofencarb and its metabolites in a fatal human poisoning case, establishing reference levels for forensic toxicology.
The findings underscore the potential for lethal outcomes from ethiofencarb intoxication, even when initially considered low toxicity.
Accurate analytical methods for ethiofencarb and its metabolites in biological samples are essential for diagnosing and investigating poisoning cases.