TY  - JOUR
PY  - 2015//
TI  - An autopsy case of death due to metabolic acidosis after citric acid ingestion
JO  - Legal medicine (Elsevier)
A1  - Ikeda, Tomoya
A1  - Usui, Akihito
A1  - Matsumura, Takashi
A1  - Aramaki, Tomomi
A1  - Hosoya, Tadashi
A1  - Igari, Yui
A1  - Ohuchi, Tsukasa
A1  - Hayashizaki, Yoshie
A1  - Usui, Kiyotaka
A1  - Funayama, Masato
SP  - 532
EP  - 534
VL  - 17
IS  - 6
N2  - A man in his 40s was found unconscious on a sofa in a communal residence for people with various disabilities. He appeared to have drunk 800ml of undiluted citric acid from a commercial plastic bottle. The instructions on the label of the beverage specified that the beverage be diluted 20- to 30-fold before consumption. The patient was admitted to an emergency hospital with severe metabolic acidosis (pH, 6.70; HCO3(-), 3.6mEq/L) and a low ionized calcium level (0.73mmol/L). Although ionized calcium and catecholamines were continuously administered intravenously to correct the acidosis, the state of acidemia and low blood pressure did not improve, and he died 20h later. Citric acid concentrations in the patient's serum drawn shortly after treatment in the hospital and from the heart at autopsy were 80.6mg/ml and 39.8mg/dl, respectively (normal range: 1.3-2.6mg/dl). Autopsy revealed black discoloration of the mucosal surface of the esophagus. Microscopically, degenerated epithelium and neutrophilic infiltration in the muscle layer were observed. In daily life, drinking a large amount of concentrated citric acid beverage is rare as a cause of lethal poisoning. However, persons with mental disorders such as dementia may mistakenly drink detergent or concentrated fluids, as in our case. Family members or facility staff in the home or nursing facility must bear in mind that they should not leave such bottles in places where they are easily accessible to mentally handicapped persons.<p />  <p>Language: en</p>
LA  - en
SN  - 1344-6223
UR  - http://dx.doi.org/10.1016/j.legalmed.2015.10.009
ID  - ref1
ER  -