Parenteral Hydrocarbon Injection and Associated Toxicities: Two Case Reports
A 23-year-old male injected himself with WD-40™ in a suicide attempt approximately 12 hours prior to presentation in the emergency department (ED). The patient stated he was feeling more depressed due to social situations of being unemployed and living out of his car with his fiancée. In a suicide attempt with his fiancée (Case 2), he injected WD-40™ intravenously via the right basilic vein. The couple sprayed the WD-40™ into a cup and used an insulin syringe to aspirate the hydrocarbon to inject 1 mL at a time. He self-injected nearly 15 times (15 mL) throughout the night until roughly 12 hours later he began to feel “heavy in the lungs” and then called Emergency Medical Services (EMS). He complained of nausea with 4 episodes of emesis, difficulty breathing, headache and diffuse joint pain. Past medical history is significant for IV heroin use and he does not take any prescription medications. Vital signs on arrival included a temperature of 101.7 °F, blood pressure of 120/57 mmHg, pulse of 116 beats per minute (bpm), respiratory rate of 20 breaths per minute, and oxygen saturation (SpO2) of 93% on room air. Physical exam noted rales in the right lung base, but no respiratory distress or retractions, and bilateral antecubital skin injection sites with track marks but no overlying skin irritation. Laboratory evaluation revealed a white blood cell count (WBC) of 11.2 k/mm,3 hemoglobin 14 g/dL, serum creatinine 1.39 mg/dL, and arterial blood gas (ABG) on room air with pH 7.45, pCO2 32.8 mmHg, pO2 51 mmHg, HCO3 23 mmol/L, and oxygen saturation of 88%. Urine qualitative drug screen was positive only for opiates. Additionally, serum ethanol, acetaminophen, and aspirin concentrations were non-detectable. Chest radiograph (CXR) in the ED demonstrated pulmonary edema with right lower lobe infiltrate (). Radiograph of the patient’s right elbow over the injection site did not demonstrate foreign body or subcutaneous emphysema. The patient was treated with supplemental oxygenation via non-rebreather mask, 40 mg of IV furosemide, 1 gm of ceftriaxone, 800 mg of ibuprofen, and 1 gm of acetaminophen. His maximum temperature was 103.3 °F in the ED. With supplemental oxygenation, the patient’s SpO2 improved to 99%. The patient was admitted to the intensive care unit (ICU). By hospital day 2, his pulmonary edema and chemical pneumonitis improved with supplemental oxygenation and methylprednisolone 125 mg IV once daily. He did not require additional doses of diuretics.\nHe developed cellulitis of the right upper extremity near the injection site in the right antecubital fossa on the second hospital day and was started on 1 gm of vancomycin and 3.375 gm piperacillin/tazobactam. Repeat laboratory studies on hospital day 2 demonstrated increasing leukocytosis with WBC 16.4 k/mm3 with 5% band neutrophils and 76% segmented neutrophils. The cellulitis progressed into an abscess and on hospital day 7, the patient was taken to the operating room for incision and drainage. The procedure demonstrated liquefied necrotic subcutaneous tissue, which was debrided and excised, and the wound was packed with iodoform gauze. Culture of the abscess revealed no growth of any organisms. After incision and drainage, the patient improved clinically with reduction in pain and redness in his right upper extremity. CXR findings resolved () by hospital day 3, and he was discharged after 9 days to inpatient psychiatric care.