An autopsy case of fatal repellent air freshener poisoning

•First autopsy case of repellent air freshener poisoning death.•Non-ionic surfactant was absorbed into the blood from alimentary tract within one hour of ingestion.•Small amounts of non-ionic surfactant can cause death for an aged person.•This case enlightens the importance of preventing accidental ingestion of toxic substances.

We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1 h after the collapse, he was in cardiopulmonary arrest and subsequently died 10 h after his arrival. The forensic autopsy performed 5.5 h after death revealed the 380 ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1 μg/ml and 558.2 μg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household.