A Fatal Case of Poisoning with Carbon

C. McI., a man aged 26 years, a joiner, on August 12. 1953. during the course of a bout of alcoholism. consumed a quantity of carbon tetrachloride in the form of " thawpit." Shortly afterwards he became intensely nauseated, but was unable to vomit for several hours. Thereafter, however, and for the following 48 hours vomiting was intractable. During this time he complained of pain in the chest, lower abdomen, and both lumbar regions. and experienced frequency of micturition. On admission to a peripheral hospital on August 14 he did not look gravely ill, but a slight icteric staining of conjunctivae and skin was observed. He had a low-grade pyrexia (99° F.) and there was evidence of mild bronchitis. The liver was slightly enlarged and tender on palpation. Examination of the urine disclosed a trace of albumin together with scanty red and white blood cells. Blood examination furnished the following results: haemoglobin, 13.3 g. per 100 ml. white blood cells, 12.400 per c.mm. He was transferred to Raigmore Hospital, Inverness. on August 17. During the ensuing 24 hours the clinical picture did not alter materially, with the exception that there was evidence of patchy pulmonary consolidation, and the patient experienced occasional haemoptyses. Jaundice was slightly deeper but was never marked. The following investigations were carried out. Urine analysis gave: albumin ++, bilirubin ++, red blood cells + +, white blood cells + : fine granular casts and epithelial debris were present. The E.S.R. was 37 mm. in one hour (Wintrobe). haemoglobin 13.8 g. per 100 ml., and white blood cells 13.800 per c.mm. (polymorphs 760°.. Iymphocytes 22°. monocytes 2%o). No tubercle bacilli or other pathogens were isolated in sputum. Blood cultuires proved negative. An agglutination reaction (including leptospira) was negative, as was a search for leptospira in the urine. On August 19 a marked degree of oliguria developed followed within a few hours by symptoms and signs of a generalized haemorrhagic bronchopneumonia and pulmonary oedema. Gross cyanosis was associated with a respiratory rate of 40 per minute; pulse rate 110 per minute, temperature 100F. Oliguria persisted and the patient died on August 20, eight davs after the ingestion of carbon tetrachloride. The patient did not admit to exposure to any toxic material in his occupation. and it was only some time after his death that we learned he had consumed carbon tetrachloride. The history given above was reconstructed for the sake of clarity. He was indeed suspected initially of suffering from leptospiral jaundice on the clinical evidence of hepatorenal injury, bronchitis. pyrexia. leucocytosis. and a history of occupational exposure to rats. This gives point to the contention of Partenheimer and Citron (1952) that carbon tetrachloride poisoning is often not diagnosed because it is not considered in the differential diagnosis and therefore a history of exposure is not soLight.