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Dangerous Mixture of Household Detergents in an Old-style Toilet: a Case Report with Simulation Experiments of the Working Environment and Warning of Potential Hazard Relevant to the General Environment

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Masao Katsumata

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Kazumasa Miyake

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Hirofumi Inagaki

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Xiao-Hui Fan

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Hideo Kubota

Department of Hygiene and Public Health, Nippon Medical School, Tokyo

Yoko Yamano

Department of Hygiene and Public Health, Tokyo Women's Medical College, Tokyo

Osamu Kimura

Department of Internal Medicine, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan

A housewife cleaned toilet porcelain connected directly to a sewage storage tank with a mixture of cleaning agents; sodium hypochlorite (NaOCl) and hydrochloric acid (HCl) solutions. She complained of insomnia on the night after cleaning and suffered from severe metabolic acidosis with extremely low blood pH, PCO₂ and bicarbonate values. She recovered from the acidosis after bicarbonate transfusion, plasmapheresis and plasma exchange. Permanent blindness ensued, however, from the third day after the event. These clinical symptoms suggested that the toxic substances responsible were chloramine and methyl chloride. Their generation was confirmed by in-vitro experiments, mixing NaOCl, HCl and pooled urine from normal people. In the simulation, the methyl chloride level far exceeded (100 000 ppm) the maximal allowable concentration recommended (ca 400 ppm) by the American Conference of Governmental Industrial Hygienists (ACGIH). Chloramine's toxic actions were confirmed using purified enzyme assay, and the inhibition of carbonic anhydrase and aldehyde dehydrogenase and the enhancement of superoxide dismutase activity were confirmed in neutral pH. The patient's clinical symptoms suggested that insomnia and permanent blindness seemed to be partly ascribable to chronic repetitive exposure to methyl chloride; catching a cold, drug intake and alcohol intake, in addition, precipitated the patient's visual loss. The possibility of this kind of intoxication with such a mixture of agents may lie latent in any situation where sewage or garbage are exposed to the open air.

Human & Experimental Toxicology, Vol. 11, No. 1, 27-34 (1992)
DOI: 10.1177/096032719201100104


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