Case Report

Catastrophic Toxic Alcohol Poisoning from Liquor and Perfume Ingestion: A Case of Rapid Neurological Deterioration and Multi-Organ Dysfunction

Authors: EL MAWLA Zeinab MD, MROUEH Fatima, TOFAILI Hawraa, KHALIL MOURAD Nina MD, TALEB Hussein, MOLLAEI Chirine MD.

DOI: 10.33425/3065-5641.1019

---

Abstract

Background: Alcohol intoxication, whether from conventional or unconventional sources, can lead to severe metabolic disturbances and neurological injury. Ethanol-containing consumer products, such as colognes and perfumes, are sometimes intentionally ingested, particularly by individuals with alcohol use disorder, despite containing denatured alcohol. Ingestion of perfume is uncommon in adults but poses a dual risk: ethanol intoxication and toxicity from denaturants and co-solvents like methanol and propylene glycol. This case report highlights the severe consequences of such ingestions.

Case Presentation: We present the case of a 28-year-old female with a history of major depressive disorder and chronic alcohol use disorder who ingested a massive quantity of vodka (>750 mL), perfume (≈750 mL), and an overdose of escitalopram. This led to catastrophic toxic alcohol poisoning, resulting in rapid neurological deterioration and multi-organ dysfunction, including refractory mixed metabolic acidosis, central diabetes insipidus, delayed acute kidney injury, and severe thrombocytopenia. Despite aggressive treatment, including hemodialysis, she progressed to brain death within a few hours of presentation.

Discussion: This case underscores the critical dangers associated with the ingestion of ethanol-based cosmetics, particularly in large volumes. The combined presence of ethanol, methanol (a common denaturant), and propylene glycol created a complex toxicological scenario. The discussion details the pathophysiology of her presentation, focusing on the interplay of these toxic agents, the evolution of acid-base disturbances, and the mechanisms underlying the observed organ dysfunctions, including delayed acute kidney injury and severe thrombocytopenia. The challenges in managing such refractory conditions and the importance of early intervention are also explored.

Conclusion: This case report emphasizes the life-threatening risks of ingesting ethanol-based cosmetics and highlights the rapid and severe progression of multi-organ dysfunction that can ensue. It underscores the importance of a high index of suspicion for toxic alcohol ingestion in patients presenting with severe metabolic acidosis and neurological compromise, even when initial ethanol levels are unavailable. The case also illustrates the complex acid-base dynamics, the development of central diabetes insipidus as a sentinel sign of brain death, and the delayed onset of acute kidney injury and thrombocytopenia due to multiple contributing factors. Early aggressive treatment, including hemodialysis and supportive care, is crucial, but prevention through multidisciplinary efforts remains paramount.

View / Download PDF