Chloroform ingestion causing severe gastrointestinal injury, hepatotoxicity and dermatitis confirmed with plasma chloroform concentrations.

CONTEXT: Poisoning due to chloroform ingestion is rare. The classic features of acute chloroform toxicity include central nervous system (CNS) and respiratory depression, and delayed hepatotoxicity. CASE DETAILS: A 30-year-old female ingested 20-30 mL of 99% chloroform solution, which caused rapid loss of consciousness, transient hypotension and severe respiratory depression requiring endotracheal intubation and ventilation. She was alert by 12 h and extubated 16 h post-overdose. At 38-h post-ingestion, her liver function tests started to rise and she was commenced on intravenous acetylcysteine. Her alanine transaminase (1283 U/L), aspartate transaminase (734 U/L) and international normalized ratio (2.3) peaked 67- to 72-h post-ingestion. She also developed severe abdominal pain, vomiting and diarrhoea. An abdominal CT scan was consistent with severe enterocolitis, and an upper gastrointestinal endoscopy showed erosive oesophagitis, severe erosive gastritis and ulceration. She was treated with opioid analgesia, proton pump inhibitors, sucralfate and total parenteral nutrition. Secretions caused a contact dermatitis of her face and back. Nine days post-ingestion she was able to tolerate food. Her liver function tests normalized and the dermatitis resolved. Chloroform was measured using headspace gas chromatograph mass spectrometry, with a peak concentration of 2.00 µg/mL, 4 h 20 min post-ingestion. The concentration-time data fitted a 1-compartment model with elimination half-life 6.5 h. DISCUSSION: In addition to early CNS depression and delayed hepatotoxicity, we report severe gastrointestinal injury and dermatitis with chloroform ingestion. Recovery occurred with good supportive care, acetylcysteine and management of gastrointestinal complications.

Tectonic influences on ground water quality: insight from complementary methods.

A study using multiple techniques provided insight into tectonic influences on ground water systems; the results can help to understand ground water systems in the tectonically active western United States and other parts of the world. Ground water in the San Bernardino Valley (Arizona, United States and Sonora, Mexico) is the main source of water for domestic use, cattle ranching (the primary industry), and the preservation of threatened and endangered species. To improve the understanding of ground water occurrence, movement, and sustainability, an investigation was conducted using a number of complementary methods, including major ion geochemistry, isotope hydrology, analysis of gases dissolved in ground water, aquifer testing, geophysics, and an examination of surface and subsurface geology. By combining information from multiple lines of investigation, a more complete picture of the basin hydrogeology was assembled than would have been possible using fewer methods. The results show that the hydrogeology of the San Bernardino Valley is markedly different than that of its four neighboring basins in the United States. The differences include water quality, chemical evolution, storage, and residence time. The differences result from the locally unique geology of the San Bernardino Valley, which is due to the presence of a magmatically active accommodation zone (a zone separating two regions of normal faults with opposite dips). The geological differences and the resultant hydrological differences between the San Bernardino Valley and its neighboring basins may serve as a model for the distinctive nature of chemical evolution of ground water in other basins with locally distinct tectonic histories.