An intriguing case of polyvinyl chloride solvent cement poisoning: A case report

An intriguing case of polyvinyl chloride solvent cement poisoning: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report An intriguing case of polyvinyl chloride solvent cement poisoning: A case report S N Marambahewa, D A C T Chandrasiri, W A I C Weerasekara, B M Munasinghe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3882101/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : S-Lon® ( S ) is a locally produced polyvinyl chloride (PVC)-based solvent cement. It is a clear, slightly viscous liquid. Other constituents include 1-cyclohexanone, 3-butanone, and 1-acetone. It is used ubiquitously for building construction in Sri Lanka. Although theclinical effects of the compound have not yet been ascertained, the constituents have been implicated in neurotoxicity, eye and skin irritation, and delayed liver and renal injury. Case Description: A 42-year-old South Asian male presented following self-ingestion of S . His vital parameters were stable,and he was initially managed symptomatically. A few hours later,he developed central nervous system (CNS) depression and stridor requiring elective intubation. An examinationof the upper airway revealed inflammation and edema. He was sedated and ventilated, and IV dexamethasone was administered. Attempts at removing the nasogastric tube (NGT) after extubation on day 3failed. The patient had to be reintubated and sedated due to extreme agitation not responding to routine doses of sedatives. The NGT wasamalgamated after reacting with S, forming a solid clump, which was later found after removal . The posterior pharynx and nasopharynx were packed and subsequentlyremoved before extubation. The patient made a full recovery and was transferred to the ward on day 05. Conclusion: The ingestion of a sufficient quantity of S could result in gut absorption with CNS depression, coma, and even death. No antidotes areavailable for toxicity, and management is largely supportive. As witnessed in our patient, chemical laryngitis and upper airway inflammation may lead to upper airway obstruction. Chemical reactions involvingmedical equipment may lead to unforeseen outcomes. Critical Care & Emergency Medicine Toxicology S-Lon polyvinyl chloride solvent cement polymer cyclohexanone neurotoxicity nasogastric tube Figures Figure 1 Introduction S- lon® (S) is a locally produced polyvinyl chloride (PVC)-based solvent cement ( 1 ). It is highly flammable and a clear, slightly viscous liquid. Other constituents include 1-cyclohexanone, 3-butanone, and 1-acetone. It is used ubiquitously for building construction in Sri Lanka. Although the clinical effects of this compound have not yet been ascertained, the constituents have been implicated in neurotoxicity, eye and skin irritation and delayed liver and renal injury ( 1 ). The ingestion of a sufficient quantity of nutrients could result in gut absorption, resulting in central nervous system (CNS) depression, coma, and even death ( 1 ). Deliberate self-ingestion is extremely rare. Here, we report a case in which a young South Asian individual presented with self-ingestion of Z, subsequent CNS depression requiring elective intubation, and difficult removal of a nasogastric tube (NGT) due to amalgamation requiring ear, nose, and throat (ENT) input. Case Description A 42-year-old South Asian male presented to the emergency treatment unit of a District General Hospital in Sri Lanka following deliberate self-ingestion of S during a suicidal attempt. No other toxins were found in the vicinity. His past medical, surgical, and allergy history was unremarkable. Patients were admitted within 90 minutes following ingestion. On admission, his airway was patent with equal bilateral air entry without added sounds, his respiratory rate was 16 breaths/minute with a shallow breathing pattern and capillary O 2 saturation of 92% in room air. The pulse rate was 110 bpm, and the capillary refill time was less than 2 seconds, with a blood pressure of 140/85 mmHg. The GCS score was 11/15 (E-3, V-3, M-5), and bilateral pupils were 3 mm in size and equally reacted to light. Fundoscopy did not reveal papilloedema. The capillary blood glucose level was 130 mg/dl. The patient was managed symptomatically with a facemask O 2 of 10 L/min. He was catheterized, and an input-output chart was generated. 16G NGT was inserted and treated with activated charcoal. Then, 150 ml of 3% saline was given over 90 minutes to alleviate possible cerebral edema. Blood was sent for investigations, including venous blood gas analysis. The latter yielded a normal acid-base status, electrolyte concentration, and lactate concentration. An electrocardiogram revealed sinus tachycardia at a rate of approximately 120 bpm. An X-ray of the chest was normal. The patient’s GCS gradually deteriorated, and airway patency was simultaneously reduced with stridor. He was intubated under direct laryngoscopy following rapid sequence induction with IV propofol 2 mg/kg, IV suxamethonium 2 mg/kg, and cricoid pressure by an anesthetist. The pharynx appeared inflamed. An 8 mg dose of intravenous dexamethasone was administered. Her arterial blood gas after intubation revealed a pH of 7.43, a PCO2 of 27 mmHg, a PO2 of 241 mmHg, a lactate concentration of 4.3 mmol/l, and a base excess of -5 mmol/l. A 500 ml 0.9% saline bolus was administered, and the maintenance fluid was increased to 120 ml/hr. The patient was admitted to the ICU for further management and monitoring. His initial blood test results are shown in Table 1 . Table 1 Initial blood investigations Investigation Results Reference Total white cell count 10.94 x 10 9 /µl 4–11 Neutrophils 59% 50–80 Lymphocytes 31% 30–40 Hemoglobin 13.1 g/dl 11–14 Hematocrit 42.4% 35–45 Platelet count 322 x 10 9 /µl 15–450 C-reactive protein 4.4 mg/l < 6 Creatinine 1.06 mg/dl 0.7–1.3 Serum Sodium 131 mmol/l 135–145 Serum Potassium 3.7 mmol/l 3.5–5.5 Serum Urea 15 mg/dl 6–24 PT 10.2 s 15 INR 0.89 < 1.5 APTT 28.5 s 33 AST 179 U/l 8–33 ALT 196 U/l 7–56 Total Bilirubin 0.9 µmol/l 1.8–20 At the ICU, the patient was sedated and paralyzed to carry out lung and neuro-protective ventilation. Supportive care was given to the patient with stress ulcer and thromboprophylaxis. ENT referral was performed to assess the laryngeal and pharyngeal areas under fiberoptic laryngoscopy (FOL), and the findings were compatible with chemical laryngitis with mildly inflamed glottis, epiglottis, mildly edematous subglottic area and vestibule of the larynx. Regular intravenous dexamethasone was administered. The patient was kept nil by mouth for the first two days, and NG feeding commenced after 48 hours. Her liver enzymes gradually decreased to normal levels. On day 3, sedation was stopped. The GCS score improved to 10 + T (ETT). Successful extubation of the trachea was performed. Repeat FOL revealed that the laryngopharyngeal edema had now resolved. The patient appeared anxious and did not tolerate the NGT. As the patient tolerated clear fluids via the oral route, the decision was made for fluid removal. Removal failed as the NGT was found to be lodged in the nasopharynx, and attempts at pushing it back toward the oropharynx were unsuccessful. The patient became extremely anxious and did not respond to routine doses of sedatives. For the safety of the patient and the staff, he was reintubated and sedated. Subsequently, the NGT was removed by the ENT surgeon, and the procedure was mildly traumatic, with mild bleeding from the nasopharynx. The nasopharynx was packed with adrenaline-soaked gauze, a Foley catheter was inserted, and the bulb was kept inflated for tamponade. The distal end of the NGT had formed a clump after reacting with S, which led to initial failure during removal. The ENT team's advice was to keep the pack for 48 hours, after which the ENT team could remove the pack and the catheter. The FOL test was repeated, and inflammation in the laryngopharyngeal area improved with the absence of significant bleeding. The leak test was repeated, and the results were found to be positive. Figure 1 ). The nasal pack was removed after 48 hours, and the patient’s trachea was extubated. Oral feeding was gradually started. He was discharged to the ward on day 05. The psychiatry referral was performed at the ward, and upper GI endoscopy was arranged at a tertiary care center within 2 weeks. Toxicology studies were not carried out because these studies were not available freely in this low-resource setting. Discussion S is classified as a hazardous substance and Schedule 5 poison according to the manufacturer ( 1 ). It consists of polyvinyl chloride polymer, and the main constituent is 1-cyclohexanone (25–70%), which is a mixture of 3-butanone (1–15%) and 1-acetone (0–10%). Doses and plasma concentrations leading to toxicity have been studied in animals, but relevant human data for the product as a whole are not available ( 1 ). BPA has been found to cause toxic effects after exposure in humans, including in the dermal, eye, pulmonary, gastrointestinal and nervous systems ( 2 ). Cyclohexanone toxicity is rare in humans and animals used for experimental purposes ( 3 ). Inhalation is the predominant route of toxicity and can lead to respiratory tract irritation and skin irritation, eye irritation and CNS depression in large quantities ( 4 – 5 ). Toxicity after the ingestion of cyclohexanone-containing organic solvents has not been reported elsewhere, according to our knowledge, and thus lacks data on definite management. It is possible that our patient (initially managed in the emergency treatment unit) developed upper airway obstruction (indicated by the onset of stridor) due to upper airway inflammation caused by S and subsequently developed hypoxia and hypercarbia, resulting in reduced consciousness. Arterial blood gas analysis was performed after intubation, mechanical ventilation and stabilization, which might not reflect the preceding parameters. Similarly, CNS depression directly due to the toxicity of S can also be a causative factor, although the risk is low following ingestion ( 1 ). According to the manufacturers, following acute ingestion, active vomiting is discouraged, and measures should be taken to prevent aspiration in patients who are vomiting ( 1 ). Supportive therapy in the form of supplementary oxygen and correction of electrolytes are similarly advocated. Activated charcoal adsorbs nonpolar, poorly water-soluble compounds ( 6 ). S is described as a partially miscible substance in water; thus, the use of activated charcoal is justified in the case of significant ingestion. As witnessed in our patient, any clinical features of respiratory tract inflammation and airway compromise indeed warrant heightened alertness to identify and manage life-threatening compromise early. In animal studies, cyclohexanone has been implicated in delayed liver, renal and hematological derangements. It is thus prudent to monitor human exposures for an extended period. S is commercially used as a bonding material for polyvinyl chloride (PVC) tubing ( 1 ). Interestingly, the NGT used in this patient was made of PVC. The ingested S likely led to the amalgamation of the distal end of the NGT. Due to the multiple distal side openings in the NGT, the procedure would have been functional until removal. We came across a recent case report of a young male who presented with small bowel obstruction 8 months after ingestion of chlorinated PVC solvent cement and was found to have an ileal perforation during open laparotomy ( 7 ). Conclusion S poisoning following ingestion is seldom reported in the literature. Clinicians need to be aware of the potential underlying airway and CNS emergencies. Here, we likely present the first case of poisoning following ingestion of S. Initial resuscitation, continued in-hospital monitoring and multidisciplinary care resulted in the management of uncommon and unanticipated clinical challenges and, importantly, a favorable outcome. Abbreviations S- lon® S polyvinyl chloride PVC nasogastric tube NGT central nervous system CNS ear, nose, and throat ENT Glasgow coma score GCS Fiberoptic laryngoscopy FOL Declarations Ethics approval and consent to participate : Not applicable Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Availability of data and materials: Data sharing does not apply to this article, as no datasets were generated or analyzed during the current study. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable Authors' contributions: SM, TD and CW managed the patient. All the authors contributed as authors to this manuscript in terms of planning, conception and design; writing and editing various drafts of the manuscript; and reading and approving the final manuscript. Acknowledgments: The authors would like to recognize and acknowledge all the clinical and nonclinical staff who were involved in the management of the patient. References Material Safety Data Sheet – S-lon Solvent Cement (2019). S-lon Lanka (Pvt) Ltd. Available at: http://www.slon.lk/storage/app/uploads/public/5c6/553/807/5c655380761f5778136896.pdf (Accessed: Dec 3, 2023). Cyclohexane Incident Management (2016). Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566904/cyclohexane_ incident_management.pdf (Accessed: Dec 3, 2023). Lee YH, Chung YH, Kim HY, Shin SH, Lee SB. Subacute Inhalation Toxicity of Cyclohexanone in B6C3F1 Mice. Toxicol Res. 2018 Jan;34(1):49-53. doi: 10.5487/TR.2018.34.1.049. Epub 2018 Jan 15. PMID: 29372001; PMCID: PMC5776916. New Jersey department of health. Hazardous substance fact sheet. 2009 Available from: http://www.nj.gov/health/eoh/rtkweb/documents/fs/0164.pdf/(Accessed: Dec 3, 2023). National Center for Biotechnology Information (2024). PubChem Compound Summary for CID 7967, Cyclohexanone. Retrieved January 13, 2024 from https://pubchem.ncbi.nlm.nih.gov/compound/Cyclohexanone. Chacko B, Peter JV. Antidotes in Poisoning. Indian J Crit Care Med. 2019 Dec;23(Suppl 4):S241-S249. doi: 10.5005/jp-journals-10071-23310. PMID: 32020997; PMCID: PMC6996653. Huzaifa M, Sistla SC, Kumari S. An Unusual Case of Small Bowel Obstruction Caused by Chlorinated Polyvinyl Chloride Solvent Cement Consumption. Indian Journal of Surgery. 2023 Jun;85(3):652-4 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3882101","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":268283644,"identity":"a465db22-ce07-4c3f-b1ce-91796bd361d2","order_by":0,"name":"S N Marambahewa","email":"","orcid":"","institution":"District General Hospital, Mannar, Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"S","middleName":"N","lastName":"Marambahewa","suffix":""},{"id":268284169,"identity":"2c87d852-ce2b-4538-8fe8-e508505922ea","order_by":1,"name":"D A C T Chandrasiri","email":"","orcid":"","institution":"District General Hospital, Mannar, Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"D","middleName":"A C T","lastName":"Chandrasiri","suffix":""},{"id":268284170,"identity":"c1db84f8-a168-4845-90e4-f63d82f0b698","order_by":2,"name":"W A I C Weerasekara","email":"","orcid":"","institution":"District General Hospital, Mannar, Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"W","middleName":"A I C","lastName":"Weerasekara","suffix":""},{"id":268284171,"identity":"fb2c0e4b-1e05-4de3-add9-46d8943280d6","order_by":3,"name":"B M Munasinghe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFAC5gbGBgY5Bgb2BiDHwIIYLYwgLcYMDDwHQFokSNEikQDiEaFFt/1g48cZNQbR5pLPr274USDBwN/enYBXi9mZxGbJDccMcnfOzim72QN0mMSZsxvwazmQ2CD5gO1P7obbOWk3eIBaDCRyCWg5/7D554N/Brkbbp5Ju/mHKC03EtskN7YBtdxgP3abOFtuPGyznNkH9EtPDtttGQMJHsJ+OZ98+GbPN4Pc7ezHn91888dGjr+9F78WODBg4DEA0TzEKYdoYX9AvOpRMApGwSgYUQAASmtQqyCnKzsAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-8373-4752","institution":"Ministry of Health, Sri Lanka","correspondingAuthor":true,"prefix":"","firstName":"B","middleName":"M","lastName":"Munasinghe","suffix":""}],"badges":[],"createdAt":"2024-01-20 17:08:55","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3882101/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3882101/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50049341,"identity":"cc936169-ad2a-4bec-bf50-fa042afbbeec","added_by":"auto","created_at":"2024-01-23 16:32:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29002,"visible":true,"origin":"","legend":"\u003cp\u003eThe clump of solvent cement (illustrated in white) formed at the distal end of the NGT (photo taken after the removal).\u003c/p\u003e","description":"","filename":"NGT.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3882101/v1/67b8af8f4b4f1c0708e40596.jpg"},{"id":50050709,"identity":"195b0f7b-1966-4765-a869-eb2505bbf46b","added_by":"auto","created_at":"2024-01-23 16:40:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":272450,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3882101/v1/3fd56b92-28b9-4376-9de2-da6e3497eaa1.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAn intriguing case of polyvinyl chloride solvent cement poisoning: A case report \u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eS- lon® (S) is a locally produced polyvinyl chloride (PVC)-based solvent cement (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is highly flammable and a clear, slightly viscous liquid. Other constituents include 1-cyclohexanone, 3-butanone, and 1-acetone. It is used ubiquitously for building construction in Sri Lanka. Although the clinical effects of this compound have not yet been ascertained, the constituents have been implicated in neurotoxicity, eye and skin irritation and delayed liver and renal injury (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The ingestion of a sufficient quantity of nutrients could result in gut absorption, resulting in central nervous system (CNS) depression, coma, and even death (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Deliberate self-ingestion is extremely rare. Here, we report a case in which a young South Asian individual presented with self-ingestion of Z, subsequent CNS depression requiring elective intubation, and difficult removal of a nasogastric tube (NGT) due to amalgamation requiring ear, nose, and throat (ENT) input.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Case Description","content":"\u003cp\u003eA 42-year-old South Asian male presented to the emergency treatment unit of a District General Hospital in Sri Lanka following deliberate self-ingestion of S during a suicidal attempt. No other toxins were found in the vicinity. His past medical, surgical, and allergy history was unremarkable. Patients were admitted within 90 minutes following ingestion. On admission, his airway was patent with equal bilateral air entry without added sounds, his respiratory rate was 16 breaths/minute with a shallow breathing pattern and capillary O\u003csub\u003e2\u003c/sub\u003e saturation of 92% in room air. The pulse rate was 110 bpm, and the capillary refill time was less than 2 seconds, with a blood pressure of 140/85 mmHg. The GCS score was 11/15 (E-3, V-3, M-5), and bilateral pupils were 3 mm in size and equally reacted to light. Fundoscopy did not reveal papilloedema. The capillary blood glucose level was 130 mg/dl.\u003c/p\u003e\u003cp\u003eThe patient was managed symptomatically with a facemask O\u003csub\u003e2\u003c/sub\u003e of 10 L/min. He was catheterized, and an input-output chart was generated. 16G NGT was inserted and treated with activated charcoal. Then, 150 ml of 3% saline was given over 90 minutes to alleviate possible cerebral edema. Blood was sent for investigations, including venous blood gas analysis. The latter yielded a normal acid-base status, electrolyte concentration, and lactate concentration. An electrocardiogram revealed sinus tachycardia at a rate of approximately 120 bpm. An X-ray of the chest was normal. The patient’s GCS gradually deteriorated, and airway patency was simultaneously reduced with stridor. He was intubated under direct laryngoscopy following rapid sequence induction with IV propofol 2 mg/kg, IV suxamethonium 2 mg/kg, and cricoid pressure by an anesthetist. The pharynx appeared inflamed. An 8 mg dose of intravenous dexamethasone was administered. Her arterial blood gas after intubation revealed a pH of 7.43, a PCO2 of 27 mmHg, a PO2 of 241 mmHg, a lactate concentration of 4.3 mmol/l, and a base excess of -5 mmol/l. A 500 ml 0.9% saline bolus was administered, and the maintenance fluid was increased to 120 ml/hr.\u003c/p\u003e\u003cp\u003eThe patient was admitted to the ICU for further management and monitoring. His initial blood test results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInitial blood investigations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvestigation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResults\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal white cell count\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.94 x 10\u003csup\u003e9\u003c/sup\u003e/µl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4–11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50–80\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocytes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30–40\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.1 g/dl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11–14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematocrit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35–45\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet count\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e322 x 10\u003csup\u003e9\u003c/sup\u003e/µl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15–450\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 mg/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt; 6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06 mg/dl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7–1.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Sodium\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 mmol/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135–145\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Potassium\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 mmol/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5–5.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Urea\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 mg/dl\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6–24\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.2 s\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt; 1.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.5 s\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179 U/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8–33\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196 U/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7–56\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Bilirubin\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9 µmol/l\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8–20\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eAt the ICU, the patient was sedated and paralyzed to carry out lung and neuro-protective ventilation. Supportive care was given to the patient with stress ulcer and thromboprophylaxis. ENT referral was performed to assess the laryngeal and pharyngeal areas under fiberoptic laryngoscopy (FOL), and the findings were compatible with chemical laryngitis with mildly inflamed glottis, epiglottis, mildly edematous subglottic area and vestibule of the larynx. Regular intravenous dexamethasone was administered. The patient was kept nil by mouth for the first two days, and NG feeding commenced after 48 hours. Her liver enzymes gradually decreased to normal levels. On day 3, sedation was stopped. The GCS score improved to 10 + T (ETT). Successful extubation of the trachea was performed. Repeat FOL revealed that the laryngopharyngeal edema had now resolved. The patient appeared anxious and did not tolerate the NGT. As the patient tolerated clear fluids via the oral route, the decision was made for fluid removal. Removal failed as the NGT was found to be lodged in the nasopharynx, and attempts at pushing it back toward the oropharynx were unsuccessful. The patient became extremely anxious and did not respond to routine doses of sedatives. For the safety of the patient and the staff, he was reintubated and sedated. Subsequently, the NGT was removed by the ENT surgeon, and the procedure was mildly traumatic, with mild bleeding from the nasopharynx. The nasopharynx was packed with adrenaline-soaked gauze, a Foley catheter was inserted, and the bulb was kept inflated for tamponade. The distal end of the NGT had formed a clump after reacting with S, which led to initial failure during removal. The ENT team's advice was to keep the pack for 48 hours, after which the ENT team could remove the pack and the catheter. The FOL test was repeated, and inflammation in the laryngopharyngeal area improved with the absence of significant bleeding. The leak test was repeated, and the results were found to be positive. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe nasal pack was removed after 48 hours, and the patient’s trachea was extubated. Oral feeding was gradually started. He was discharged to the ward on day 05. The psychiatry referral was performed at the ward, and upper GI endoscopy was arranged at a tertiary care center within 2 weeks. Toxicology studies were not carried out because these studies were not available freely in this low-resource setting.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cb\u003eS\u003c/b\u003e is classified as a hazardous substance and Schedule 5 poison according to the manufacturer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It consists of polyvinyl chloride polymer, and the main constituent is 1-cyclohexanone (25\u0026ndash;70%), which is a mixture of 3-butanone (1\u0026ndash;15%) and 1-acetone (0\u0026ndash;10%). Doses and plasma concentrations leading to toxicity have been studied in animals, but relevant human data for the product as a whole are not available (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). BPA has been found to cause toxic effects after exposure in humans, including in the dermal, eye, pulmonary, gastrointestinal and nervous systems (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Cyclohexanone toxicity is rare in humans and animals used for experimental purposes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Inhalation is the predominant route of toxicity and can lead to respiratory tract irritation and skin irritation, eye irritation and CNS depression in large quantities (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Toxicity after the ingestion of cyclohexanone-containing organic solvents has not been reported elsewhere, according to our knowledge, and thus lacks data on definite management.\u003c/p\u003e \u003cp\u003eIt is possible that our patient (initially managed in the emergency treatment unit) developed upper airway obstruction (indicated by the onset of stridor) due to upper airway inflammation caused by \u003cb\u003eS\u003c/b\u003e and subsequently developed hypoxia and hypercarbia, resulting in reduced consciousness. Arterial blood gas analysis was performed after intubation, mechanical ventilation and stabilization, which might not reflect the preceding parameters. Similarly, CNS depression directly due to the toxicity of \u003cb\u003eS\u003c/b\u003e can also be a causative factor, although the risk is low following ingestion (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the manufacturers, following acute ingestion, active vomiting is discouraged, and measures should be taken to prevent aspiration in patients who are vomiting (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Supportive therapy in the form of supplementary oxygen and correction of electrolytes are similarly advocated. Activated charcoal adsorbs nonpolar, poorly water-soluble compounds (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). \u003cb\u003eS\u003c/b\u003e is described as a partially miscible substance in water; thus, the use of activated charcoal is justified in the case of significant ingestion. As witnessed in our patient, any clinical features of respiratory tract inflammation and airway compromise indeed warrant heightened alertness to identify and manage life-threatening compromise early. In animal studies, cyclohexanone has been implicated in delayed liver, renal and hematological derangements. It is thus prudent to monitor human exposures for an extended period.\u003c/p\u003e \u003cp\u003e \u003cb\u003eS\u003c/b\u003e is commercially used as a bonding material for polyvinyl chloride (PVC) tubing (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Interestingly, the NGT used in this patient was made of PVC. The ingested S likely led to the amalgamation of the distal end of the NGT. Due to the multiple distal side openings in the NGT, the procedure would have been functional until removal. We came across a recent case report of a young male who presented with small bowel obstruction 8 months after ingestion of chlorinated PVC solvent cement and was found to have an ileal perforation during open laparotomy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cb\u003eS\u003c/b\u003e poisoning following ingestion is seldom reported in the literature. Clinicians need to be aware of the potential underlying airway and CNS emergencies. Here, we likely present the first case of poisoning following ingestion of \u003cb\u003eS.\u003c/b\u003e Initial resuscitation, continued in-hospital monitoring and multidisciplinary care resulted in the management of uncommon and unanticipated clinical challenges and, importantly, a favorable outcome.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eS- lon\u0026reg;\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003epolyvinyl chloride\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePVC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003enasogastric tube\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNGT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ecentral nervous system\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCNS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eear, nose, and throat\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGlasgow coma score\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGCS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFiberoptic laryngoscopy\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFOL\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing does not apply to this article,\u0026nbsp;as no datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM, TD and CW managed the patient. All\u0026nbsp;the\u0026nbsp;authors contributed as authors to this manuscript in terms of planning, conception and design;\u0026nbsp;writing and editing various drafts of the manuscript;\u0026nbsp;and reading and approving the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to recognize and acknowledge all the clinical and nonclinical staff who were involved in the management of the patient.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMaterial Safety Data Sheet \u0026ndash; S-lon Solvent Cement (2019). S-lon Lanka (Pvt) Ltd. Available at: http://www.slon.lk/storage/app/uploads/public/5c6/553/807/5c655380761f5778136896.pdf (Accessed: Dec 3, 2023).\u003c/li\u003e\n \u003cli\u003eCyclohexane Incident Management (2016). Public Health England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566904/cyclohexane_\u003cbr\u003eincident_management.pdf (Accessed: Dec 3, 2023).\u003c/li\u003e\n \u003cli\u003eLee YH, Chung YH, Kim HY, Shin SH, Lee SB. Subacute Inhalation Toxicity of Cyclohexanone in B6C3F1 Mice. Toxicol Res. 2018 Jan;34(1):49-53. doi: 10.5487/TR.2018.34.1.049. Epub 2018 Jan 15. PMID: 29372001; PMCID: PMC5776916.\u003c/li\u003e\n \u003cli\u003eNew Jersey department of health. Hazardous substance fact sheet. 2009 Available from: http://www.nj.gov/health/eoh/rtkweb/documents/fs/0164.pdf/(Accessed: Dec 3, 2023).\u003c/li\u003e\n \u003cli\u003eNational Center for Biotechnology Information (2024). PubChem Compound Summary for CID 7967, Cyclohexanone. Retrieved January 13, 2024 from https://pubchem.ncbi.nlm.nih.gov/compound/Cyclohexanone.\u003c/li\u003e\n \u003cli\u003eChacko B, Peter JV. Antidotes in Poisoning. Indian J Crit Care Med. 2019 Dec;23(Suppl 4):S241-S249. doi: 10.5005/jp-journals-10071-23310. PMID: 32020997; PMCID: PMC6996653.\u003c/li\u003e\n \u003cli\u003eHuzaifa M, Sistla SC, Kumari S. An Unusual Case of Small Bowel Obstruction Caused by Chlorinated Polyvinyl Chloride Solvent Cement Consumption. Indian Journal of Surgery. 2023 Jun;85(3):652-4\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"S-Lon, polyvinyl chloride, solvent cement, polymer, cyclohexanone, neurotoxicity, nasogastric tube","lastPublishedDoi":"10.21203/rs.3.rs-3882101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3882101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eS-Lon® (\u003cem\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/em\u003e) is a locally produced polyvinyl chloride (PVC)-based solvent cement. It is a clear, slightly viscous liquid. Other constituents include 1-cyclohexanone, 3-butanone, and 1-acetone. It is used ubiquitously for building construction in Sri Lanka. Although theclinical effects of the compound have not yet been ascertained, the constituents have been implicated in neurotoxicity, eye and skin irritation, and delayed liver and renal injury.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Description:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 42-year-old South Asian male presented following self-ingestion of \u003cem\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/em\u003e. His vital parameters were stable,and he was initially managed symptomatically. A few hours later,he developed central nervous system (CNS) depression and stridor requiring elective intubation. An examinationof the upper airway revealed inflammation and edema. He was sedated and ventilated, and IV dexamethasone was administered. Attempts at removing the nasogastric tube (NGT) after extubation on day 3failed. The patient had to be reintubated and sedated due to extreme agitation not responding to routine doses of sedatives. The NGT wasamalgamated after reacting with \u003cem\u003e\u003cstrong\u003eS,\u003c/strong\u003e\u003c/em\u003eforming a solid clump, which was later found after removal\u003cem\u003e.\u003c/em\u003e The posterior pharynx and nasopharynx were packed and subsequentlyremoved before extubation. The patient made a full recovery and was transferred to the ward on day 05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ingestion of a sufficient quantity of \u003cem\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/em\u003e could result in gut absorption with CNS depression, coma, and even death. No antidotes areavailable for toxicity, and management is largely supportive. As witnessed in our patient, chemical laryngitis and upper airway inflammation may lead to upper airway obstruction. Chemical reactions involvingmedical equipment may lead to unforeseen outcomes.\u003c/p\u003e","manuscriptTitle":"An intriguing case of polyvinyl chloride solvent cement poisoning: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-23 16:32:03","doi":"10.21203/rs.3.rs-3882101/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e99f508-7dae-49e3-b536-177414835a36","owner":[],"postedDate":"January 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28264823,"name":"Critical Care \u0026 Emergency Medicine"},{"id":28264824,"name":"Toxicology"}],"tags":[],"updatedAt":"2024-01-23T16:32:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-23 16:32:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3882101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3882101","identity":"rs-3882101","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}