Chloramide

Direct observations: clinical cases, poisoning incidents and other

Administrative data

Endpoint:

direct observations: clinical cases, poisoning incidents and other

Type of information:

other: accidental exposure

Adequacy of study:

disregarded due to major methodological deficiencies

Reliability:

4 (not assignable)

Rationale for reliability incl. deficiencies:

other: Insufficient data for assessment.The mechanism of death is unclear. The level of exposure to monochloramine is unknown.

Data source

Reference

Reference Type:

publication

Title:

Unexpected death due to chloramine toxicity in a woman with a brain tumor

Author:

Cohle S.D., Thompson W., Eisenga B.H., Cottingham S.L.

Year:

2001

Bibliographic source:

Forensic Science International 124, 137-139

Materials and methods

Study type:

poisoning incident

Endpoint addressed:

acute toxicity: inhalation

Test guideline

Qualifier:

no guideline required

Principles of method if other than guideline:

Here, a case of a woman with an undiagnosed oligodendroglioma who mixed bleach and amonia (resulting in the formation of chloramine gas), and died while cleaning her bathroom, is presented.

GLP compliance:

no

Test material

Test material information

Constituent 1

Reference substance name:

chloramine gas

IUPAC Name:

chloramine gas

Details on test material:

- Name of test material (as cited in study report): chloramine gas (following a mix of bleach and ammonia)
- Physical state: gas
- Composition of test material, percentage of components: A mix of monochloramines and dichloramines. No data on percentages.

Method

Type of population:

general

Subjects:

- Number of subjects exposed: 1
- Sex: female
- Age: 35 year-old
- Race: no data
- Known diseases: undiagnosed oligodendroglioma (brain tumor)

Ethical approval:

not applicable

Route of exposure:

inhalation

Reason of exposure:

accidental

Exposure assessment:

not specified

Details on exposure:

The victim probably mixed bleach and ammonia resulting in the formation of chloramine gas.

Examinations:

An autopsy and a drug screen were performed.

Medical treatment:

Not applicable: The victim was found dead in a confined half bathroom of her home.

Results and discussion

Clinical signs:

Not measured: The victim was found dead in a confined half bathroom of her home.

Results of examinations:

Pertinent autopsy findings included a 2.5x 3.0 x 1.0 cm low grade oligodendroglioma in the left frontal lobe of the brain. There was mild mucosal erythema of the upper airway and mild pulmonary congestion and edema. A drug screen (femoral blood) showed 100 ng/ml of diphenhydramine (therapeutic 10-110 ng/ml), 110 ng/ml of cyanide (smokers, 0-41 ng/ml; 50-500 n/ml in patients treated with nitroprusside), 13.4mcg/ml of thiocyanate (patients undergoing nitroprusside treatment, 6-29 mcg/ml), and caffeine.

Effectivity of medical treatment:

No medical treatment was realized as the victim was found dead.

Outcome of incidence:

Not relevant.

Applicant's summary and conclusion

Conclusions:

Apparently, a 35-year-old woman died following an exposure to chloramine gas. A death resulting from toxicity resulting from the mixture of cleaning agents containing bleach and ammonia.

Executive summary:

A 35 -year-old woman was found dead by her children in a small, confined half bathroom of the home that was attached to the master bedroom. The house had a very strong pungent odor. The windows and doors of the home were closed. Bleach and amonia bottles were present on the dryer in the utility room. Pertinent autopsy findings included a 2.5x 3.0 x 1.0 cm low grade oligodendroglioma in the left frontal lobe of the brain. There was mild mucosal erythema of the upper airway and mild pulmonary congestion and edema. A drug screen (femoral blood) showed 100 ng/ml of diphenhydramine (therapeutic 10-110 ng/ml), 110 ng/ml of cyanide (smokers, 0-41 ng/ml; 50-500 n/ml in patients treated with nitroprusside), 13.4 mcg/ml of thiocyanate (patients undergoing nitroprusside treatment, 6-29 mcg/ml), and caffeine. It is suspected that the death described here resulted of chloramine toxicity. The mechanism of death is unknown but several explanations are possible. (1) The victim may have asphyxiated from the chloramine gas alone. (2) The chloramine plus the oligodendroglioma may have induced a fatal seizure. (3) Incapacitation from the chloramine may have led to positional asphyxia.