Ingestion of Tetramethylethylenediamine in a Suicide Attempt 1734

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S990
• Main Authors: Sharma, Avinash V., Som, Aniruddh, Chopra, Rajus
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Gastroenterology; Suicides & suicide attempts
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01734

Ingestion of potentially toxic substances is a problem worldwide typically affecting children, however it can be a significant problem in adults especially those with psychiatric disorders. Here we present a rare case of intentional ingestion with tetramethylethylenediamine (TMEDA) in a suicide attempt and its immediate effects on the gastrointestinal system. XY is a 28 year old Chinese male with depression and hypothyroidism who presented to our ED two hours after intentional ingestion of TMEDA in a suicide attempt after an argument with his father. XY works on a university campus chemistry department. XY was obtunded upon arrival and intubated for airway protection with copious frothy, bloody secretions noted. GI was consulted and he was admitted to the ICU. Poison control was also consulted, and given limited information on this substance, recommended supportive care but did state this chemical is likely caustic and flammable. Patient underwent EGD in the ICU which revealed Grade 2 to 3 caustic esophagitis (see figures). After EGD and further stabilization he was started on proton pump inhibitors (PPI), extubated and managed with supportive care. His hospital course was also significant for inhalation pneumonitis. He underwent esophagram showing small caliber esophagus with mucosal irregularity in several locations, but no evidence of fistula, perforation or stricture. He was discharged on PPI, sucralfate, and tolerating clear then full liquids prior to discharge but with strict return precautions as it was recommended he receive enteral feeding with either G or J tube but insisted on a PO diet. TMEDA is employed in the field of organolithium chemistry and has been described as extremely destructive to mucous membranes, upper respiratory tract, eyes and skin by the Northeastern University Material Safety Data Sheet. Current literature is only available in animal models showing a variety of effects including neurological symptoms such as tremors, jerking, sluggishness, and aggressive behavior to life threatening bleeding within stomach, intestines, kidneys, and lungs. Because the application of this compound is restricted to chemical laboratories, literature on human exposure is very limited. Our case study gives an example of the potential harms of this toxic compound in the human body. Therefore, proper precautions should be made during its handling. All toxic exposure needs to be managed aggressively given the lack of any current reversal agent.