Trichloroethylene Intoxication: A Case of Acute Altered Mental Status Requiring Intensive Resuscitation

Trichloroethylene (TCE) is a hydrocarbon used commercially as a degreasing solvent. It has gradually become obsolete due to its carcinogenic properties, but many industries still use it given its cost-effectiveness. While there have been reports and studies regarding chronic exposures to TCE, very few acute cases of altered mental status requiring intensive care have been reported so far. We discuss the course of an acute case of TCE intoxication with coma and summarize its characteristics. A 50-year-old male with no previous medical history presented with acute altered mental status due to inhalation of volatile TCE in a factory. He was given brief cardiopulmonary resuscitation for suspected cardiac arrest; however, he was found to have a pulse when emergency medical services intervened. On arrival at our emergency department, he showed marked central nervous system (CNS) depression, raising concerns for acute TCE intoxication. The patient was intubated promptly, given the expected impending respiratory arrest, and received supportive treatment. TCE metabolite urinary concentrations were taken during admission. He regained consciousness readily, was extubated the next day, and then discharged after showing full recovery on day three. This patient with acute TCE intoxication required intensive care but was discharged with full recovery and no neurological deficits. There have been few reports describing acute intoxication needing intubation and its neurological outcomes. Furthermore, this report suggests urine metabolite concentration as a potential marker to predict clinical outcomes in these patients.