The Poison Review

Acute Chloroform Ingestion Successfully Treated with Intravenously Administered N-acetylcysteine. Dell’Aglio DM et al.  J Med Toxicol [Published online 15 June 2010]

Abstract

Chloroform, a halogenated hydrocarbon, has several important toxic effects:  mucosal irritation, sedation, cardiac sensitization, and hepatic damage induced by free-radical injury to centrilobular cells. Although toxicologists have long suggested that N-acetylcysteine (NAC) might help prevent or treat liver damage following chloroform ingestion, the possible benefit of this intervention has never been studied.

This case report, from Emory University and the Georgia Poison Center, describes a 19-year-old man who ingested approximately 75 mL of chloroform, was treated with general supportive measure as well as intravenous NAC, and recovered despite transiently increased levels of bilirubin and transaminases.  The authors state that his serum chloroform level (91 mcg/mL) was considerably higher than the typical levels measured in previously published cases of fatal chloroform ingestion.

It is, of course, impossible to attribute the good outcome in this case specifically to treatment with NAC.  However, I do agree with the authors’ conclusion:

“Considering that NAC therapy has such low risk and high theoretical benefit, it should be considered for use in chloroform and other halogenated hydrocarbon-induced hepatotoxicity.”