Une colle pour revêtement de sol ramenée à la maison ou quand le détournement d'un produit professionnel devient fatal pour un enfant

A 29-month-old child presented disorders of consciousness a few minutes after accidental ingestion of glue that is used specifically for floors by professionals. At home, she was comatose (Glasgow 6) and had tachycardia (130/bpm) and hypotension (80/40 mmHg). The evolution was marked by hemodynamic instability, cardiac dysrhythmia with torsades de pointe (treated by sulfate of magnesium), slow ventricular tachycardia and access of bradycardia (treated by hypertonic sodium bicarbonate, calcium gluconate and continuous adrenalin infusion) and status epilepticus (treated by clonazepam and then midazolam). The girl died 6 hours after the glue ingestion. Laboratory tests revealed a lactic metabolic acidosis (pH: 7.32 and lactates 2.26 mmol/L). The analysis by GC-MS of the glue sample identified xylenes and benzyl alcohol. In the urine, neither trichloroethylene, nor its metabolites (trichloroacetic acid and trichloroethanol) were detected by GC-MS. Although methylhippuric acid (metabolite of xylene) and benzoïc acid (metabolite of benzyl alcohol) were not detected, a high urine concentration of hippuric acid (2928 mg/L; 20.9 g/g creatinine) was observed by HPLC-DAD. The hippuric acid is formed via the conjugation of benzoic acid, the metabolite of benzyl alcohol, with glycine. The results of the toxicological analyses consolidate the diagnosis of benzyl alcohol poisoning, the main constituent of the ingested glue. Benzyl alcohol was responsible for “gasping” syndrome, a fatal multiple-organ deterioration, mainly described in small premature neonates.