The Last Dinner: Fatality of 2-Chloroethanol Intoxication

Abstract

Objective: 2-Chloroethanol (2-CE) is a solvent with a LD50 of 58 mg/kg orally in rats. In rare condition, grape farmers in Taiwan apply it on grapevines to hasten sprouting and can land themselves in potentially lethal conditions. Severe intoxication presenting with hypotension, respiratory failure, seizure, coma or mortality can occur in 24 hours even only skin or inhalational exposure. It is hard to make the correct diagnosis in cases of unknown contamination history due to lack of specific clinical signs/symptoms or availability of routine laboratory tests. Cases report: In July 2011, two couples (2 males 2 females, 40-58 years old) in Nantou County of Taiwan suffered from nausea, vomiting, shortness of breath, consciousness change and suspected convulsions 6-12 hours after dining and drinking together. One case was noted to be dead on arrival in the emergency room, and the other three rapidly progressed to coma, hypotension, cardiac arrest in 1-3 hours, and dead eventually after resuscitation. The most important laboratory finding was metabolic acidosis with blood pH value 7.223 to 7.291. This lethal outbreak caused disquiet in the public with respect to food and drink. The grape sprouting agent, 2-CE was proved to be the offender with high concentrations of 2-CE (2 to 15.3 mg/L in heart blood) and its metabolite (chloroacetate 232.6 to 590.5 mg/L in heart blood) detected in patients’ samples by Gas chromatography-mass spectrometry two weeks later. Conclusion: These cases demonstrated that 2-CE might be listed in table of deliberate poisons and should be ruled out in cases of mass poisoning.