Fatality following Deliberate Ingestion of a Chemical Hardener: Two Case Reports of Methyl Ethyl Ketone Peroxide Poisoning

Abstract

Industrial chemicals and solvents are usually highly toxic and often corrosive. In India, intentional poisoning by industrial chemicals is relatively uncommon. Methyl ethyl ketone peroxide (MEKP), an organic peroxide, is used as a chemical hardener in industries to cross-link polymers. We report two cases of intentional ingestion of this chemical hardener who presented to the Emergency with complaints of severe abdominal pain and multiple episodes of hematemesis. Despite treatment, they succumbed to death within twelve hours and seven days of ingestion, respectively. On autopsy and histopathology, corrosive features were seen in the esophagus and stomach. The pathophysiology is due to the free radicals derived from MEKP causing lipid peroxidation and cell death. Though the MEKP was not detected in the viscera during the chemical analysis, the evidence from the crime scene investigation and other collaborative sources strongly suggests that the poisoning is due to MEKP. This case emphasizes the significance of clinical presentation, autopsy findings, histopathological features, crime scene investigation, and utilizing appropriate preservatives for chemical analysis in uncommon cases like MEKP poisoning. MEKP ingestions are relatively rare in the literature, with only about thirty reported cases associated with increased mortality and morbidity. These cases highlight the role of crime scene visits and emphasize the clinical, post-mortem findings and histo-pathological features in an uncommon case of MEKP poisoning. In these cases, the workplace being the source of acquiring MEKP, provisions for safe storage and keeping container count prohibit misapplication.