Sudden Death Due to Acetone Toxicity

Background: Acetone or propanone is a volatile liquid that can be absorbed by ingestion, inhalation, and dermal routes, and is distributed throughout the body.  Case Presentation: This study presented a case of an employee of the Emergency Medical Center of North Khorasan Province, Iran, who died due to acetone poisoning. He was last seen alive approximately 4 hours before his body was found. Thus, the deceased was found 4 hours after death. He was a 25-year-old unmarried male nurse. He had a history of smoking for the last 4 years and reported diarrhea and nausea on the day before death. There was no history of diabetes or alcoholism as well as no other definite causes. According to interviews with his colleagues and family, he had no history of depression. A postmortem examination was performed to define the cause of death. Postmortem quantitative toxicological analysis with Gas Chromatography with Flame-Ionization Detection (GC-FID) presented acetone in the vitreous (35 mg/dL), blood (28 mg/dL), and urine (77 mg/dL) samples. Furthermore, in postmortem pathological analysis, highly microvascular changes and the diffuse necrosis of hepatocytes were reported. Other pathological changes in the brain and lungs were observed. No other definite medical cause of death was found. The cause of death was determined to be acute acetone intoxication.  Conclusion: Contrary to public opinion, acetone is a toxic and dangerous substance; thus, it is necessary to improve and implement public safeguards concerning acetone usage, as well as its handling, and disposal. Organ toxicity due to acetone can be a major cause of death. Other alcohol-related poisoning deaths, such as acetone and other metabolites, should be considered.