Suspected seizure-survival of a lethal dose of the rodenticide alpha-chloralose.

A 58-year-old female was admitted due to a suspected seizure. A blue colored pharyngeal fluid was visualized during intubation, which is indicative of poisoning. Clinical research revealed an ingestion of 2.4 g of alpha-chloralose, a rodenticide with a lethal dose of 1 g. Immediate detoxification by gastroscopy, gastric lavage and hemodialysis led to full recovery. Substance detection was carried out by gas chromatography-mass spectometry of a urine sample. There are only a few cases reporting poisoning by this substance. Coma and bilateral myoclonus have been reported but blue gastric fluid as the "red flag" in this case has never been described.

Caregiver-Fabricated Illness in a Child: A Case Report of Three Siblings.

Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver inducing a child's illness, leading to unnecessary and potentially harmful medical procedures and treatments. This condition can result in significant morbidity and mortality. We present the case of three siblings in Tunisia who were poisoned with chloralose by their own mother. The symptoms that the children presented with led to misdiagnoses, which resulted in the death of two of the children. Characteristics of the clinical presentation are articulated, followed by a discussion of the legal measures that apply to the offender and the role of physicians, nurses, and medicolegal experts involved in such a complex medical situation.

Alpha-chloralose poisoning in dogs and cats: a retrospective study of 33 canine and 13 feline confirmed cases.

Alpha-chloralose (AC) is an anaesthetic compound also used as a rodenticide, and has dose-dependent central nervous system mixed effects of excitation and depression. The objectives of this study were to detail the clinical and clinicopathological characteristics, as well as the treatment and prognosis, of AC toxicosis in dogs and cats. Medical records were retrospectively reviewed for AC poisoning between the years 1989 and 2004, and 33 dogs and 13 cats were included in the study. The most common clinical signs were seizures, muscle tremor, hyperaesthesia, hypothermia, salivation, myosis, stupor, coma and ataxia. Coma was more common, while salivation and ataxia were less common in cats compared to dogs. Although hypothermia was very common, especially in cats (90.9%), hyperthermia was frequently observed in dogs (21%). Treatment in all patients was supportive and symptomatic, and the most commonly used anticonvulsants were diazepam and barbiturates; however, severe unresponsive seizures in three dogs had to be controlled with inhalant gas anaesthesia. The hospitalisation period was 1-3 days, and the overall mortality rate was 6.5%. Alpha-chloralose poisoning seems to have a favourable prognosis in dogs and cats.

[Curarization for contributing symptomatic treatment of myoclonic jerks induced by chloralose poisoning]. / Curarisation en traitement symptomatique d'appoint des myoclonies induites par une intoxication par le chloralose.

Chloralose poisoning especially leads to consciousness failure and hyperexcitability with typical myoclonic jerks. In an observation of chloralose poisoning by ingestion of synthetic substance against moles, curarization by cistracurium besylate was proposed to contribute in the symptomatic treatment of myoclonus syndrome induced by chloralose poisoning and resistant to a large dose of diazepam.

1H NMR spectroscopy and GC-MS analysis of alpha-chloralose. Application to two poisoning cases.

Alpha-chloralose, a compound widely used as a rodenticide and in the control of bird pests, is readily available. Two cases of intentional poisoning are reported. Both patients became comatose and presented hypersialorrhea and myoclonal crises in the legs. They were discharged from hospital after several days. As clinical signs of alpha-chloralose poisoning lack specificity, anamnesis might be difficult, particularly in the case of delayed diagnosis. Toxicological analysis is therefore critical, and this article reports the investigation of serum and urine samples by gas chromatography-mass spectrometry (GC-MS) in the electron-impact mode, and by 1H nuclear magnetic resonance (1H NMR) spectroscopy. Non-hydrolyzed urinary samples and those hydrolyzed by beta-glucuronidase were taken into consideration. After acetylation, GC-MS analysis was based on characteristic mass-to-charge ratio values of 272 for alpha-chloralose and 206 for beta-hydroxyethyltheophylline, which was used as internal standard. Characterization of alpha-chloralose species by 1H NMR spectroscopy was performed taking two parameters into account: chemical shift and coupling-constant values. Without any pretreatment, 1H NMR spectroscopy revealed the presence of free (5.50 and 6.15 ppm) and conjugated forms of alpha-chloralose by characteristic resonances of H1 and chloral-type protons, respectively. Quantitative analysis was performed by relative integration of peak areas. Serum alpha-chloralose showed concentrations below the quantitation limit of both methods. In urine samples, the free chemical species rapidly decreased. GC-MS analysis revealed the predominence of conjugation after a beta-glucuronidase hydrolysis step. 1H NMR analysis directly showed that on admission of the first patient, average urinary concentrations were 1.73 mmol/L (535 mg/L) for the free form and 13.72 and 6.25 mmol/L for the two conjugated forms. A later enzymatic treatment confirmed the total concentration of alpha-chloralose chemical species. Analysis of alpha-chloralose in urine by either GC-MS or 1H NMR spectroscopy methods proved to be comparable.

[Graded classification of acute chloralose poisoning. 509 cases]. / Classification en grades des intoxications aiguës par le chloralose. 509 cas.

OBJECTIVE: The annual incidence of chloralose poisoning has exceeded 3 cases per 100,000 inhabitants in Tunisia since 1997. The purpose of this study was to analyze clinical features of chloralose poisoning. METHODS: We reviewed patients admitted to the intensive care unit during the last 5 years to search for chloralose poisoning. The identified cases were classed into 5 grades by clinical features: depth of coma, characteristics of the myoclonia, and cerebral trunk reflex response. RESULTS: We identified 509 cases of chloralose poisoning over the last 5 years. Seventy-five patients (14.7%) were in grade 1: drowsiness alone. Four hundred ten patients (80.8%) were in grades 2 and 3: hypertonic coma and myoclonus. The clinical course was favorable after sedation, tracheal intubation and mechanical ventilation. Twenty-three patients (4.6%) were in grades 4 and 5: hypertonic coma (Glasgow coma score = 3). Three of them died. CONCLUSION: The clinical features of chloralose poisoning depend on the ingested dose. Despite the gravity of the initial clinical presentation, prognosis is excellent if symptomatic treatment is given early, even in grade 5 cases which simulate brain death.

Testing for alpha-chloralose by headspace-GC/MS. A case report.

A case is presented involving an acute fatality resulting from self-administered alpha-chloralose, a rodenticide. A 18-year-old man was found dead at home, with several stains of vomit on the carpet. An empty box of three bags of 5 g 100% alpha-chloralose (Corbeaux nuisibles, Rhône Poulenc) was found near the body. The compound was identified and quantified by headspace gas chromatography coupled to mass spectrometry. Alpha-chloralose was converted by concentrated sulphuric acid into chloral, a volatile compound, that was, after chromatography on a HP5-MS capillary column, identified by the following ions, m/z 82, 111 and 148. Peripheral blood concentration was 175.7 mg/l. Alpha-chloralose was quantified in several tissues, indicating kidney sequestration. No other drugs, including ethanol, were detected.

Trichloroethanol is not a metabolite of alpha chloralose.

Head space capillary gas chromatography was used to detect alpha chloralose and its potent metabolite, trichloroethanol in clinical and forensic cases. Although alpha chloralose was identified in blood and urine in all cases, trichloroethanol was never detected. In a fatal case the alpha chloralose concentration in blood was 151.3 mg/l. It was concluded that trichloroethanol is not a metabolite of alpha chloralose.

[The cat has not always done it. A case of alpha-chloralose poisoning in wild birds]. / De dader ligt niet altijd op het kerkhof. Een geval van alfachloralosevergiftiging bij wilde vogels.

Neglected hens caused annoyance at a graveyard. Following veterinary advice, the authorities used alpha-chloralose-dressed feed in an attempt to sedate the animals, thus facilitating transport to a more suited place. However, the feed was also consumed by other birds. Moreover, the dosage alpha-chloralose appeared to be too high. Hence the resulting mortality struck both the hens and the wild birds. Obviously, alpha-chloralose should not be used for these applications.

Analysis of tissues of ducks poisoned by alpha-chloralose.

A method is described for the analysis of alpha-chloralose in avian tissues. The procedure involves extraction of chloralose with acetone, drying of extracts with anyhydrous magnesium sulphate, followed by derivatisation with dichlorodimethylsilane in the presence of triethylamine. The dimethylsilyl derivatives were cleaned-up using mini-columns containing Florisil and the eluates subsequently analysed by gas chromatography. Extracts were initially screened by thin-layer chromatography and the identity of derivatised extracts confirmed by gas chromatography/mass spectrometry.

The toxic effects of alpha-chloralose.

1. Alpha-chloralose, formed by the condensation of glucose with chloral, is used as a rodenticide and in the control of bird pests. 2. In two cases of poisoning with alpha-chloralose the clinical features included coma and generalized convulsions resembling the effects of strychnine more than those of chloral hydrate. 3. The principles of management are the support of vital functions in the unconscious patient and removal of unabsorbed poison by gastric lavage. Diazepam may be used to control convulsions.

Toxic myoclonus.

Several toxins produce encephalopathies in which myoclonus can be a prominent feature. These include intoxications with bismuth, methyl bromide, cooking oil containing anilines, and tetraethyl lead. The clinical features in many cases resemble the action myoclonus syndrome of posthypoxic encephalopathy.

[Voluntary chloralose poisoning]. / Intoxication volontaire par le chloralose.

The authors report 114 cases of acute poisoning by rodenticides (chloralose). The clinical symptoms associate coma, myoclonic jerks and bronchorrhea. Metabolic acidosis is a common finding. Despite the initial gravity, the prognosis of chloralose intoxication is excellent, provided that a symptomatic treatment is instituted early.