Investigations toxicologiques sur une couche

In routine, the diagnosis of an intoxication involving methanol is achieved by testing the solvent using gas chromatography with flame ionization detection. This kind of intoxication is seldom observed, but can occur after homemade alcohol products. Very few reports dealing with methanol exposure have been published in the paediatric population. After an initial negative screening in a laboratory, we have received a disposable diaper from a 2-year-old child found dead at home, with the request of additional investigations. The day before, due to moderate elevated temperature, he received paracetamol. No trauma nor injury were evidenced during the autopsy. However, the pathologist noticed asphyxia signs and a pulmonary edema. During this first step, a standard toxicological expertise found paracetamol in peripheral blood at 4.7 mg/L, but no alcohol and no drugs of abuse. The diaper was composed of layers of synthetic disposable materials, containing absorbent chemicals. This jelly substance was removed and submitted to analysis. A free-jelly and the jelly from the diaper of a 9-month-old boy worn for several hours were used as control references. Volatiles were screened using HS-GC/FID and HS-GC/MS. Xenobiotics were simultaneously screened by GC/M, LC/DAD and LC/MS. Formate ions were identified and quantified by zone capillary electrophoresis with UV reverse detection at 254 nm (P/ACE MDQ, Sciex). Paracetamol tested positive in the jelly at 51 mg/kg, close to what has been measured in the urine (69.7 mg/L) of the child. The screening of volatiles found ethanol (0.15 g/kg), isopropanol (0.10 g/kg) and methanol (0.44 g/kg), something which was not expected. To document the exposure to methanol, formate ions (methanol metabolite) were investigated. They tested positive at 10.1 mg/L, confirming exposure of the child to methanol. The analysis of the control diapers remained negative, both for volatiles, including methanol, and formate ions. Due to discrepancy results with the previous toxicological investigations, the Judge in charge of the case re-opened the file.