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O42: Two case-reports of intoxication with T61®, a mixture used in veterinary medecine - 28/06/14

Doi : 10.1016/S2352-0078(14)70050-2 
B. Lelièvre 1, C. Abbara 1, H. Benatre 1, S. Férec 1, M. Bretaudeau 2, C. Gegu 2, C. Bruneau 2, D. Boels 2, P. Harry 2, A. Turcant 2, B. Diquet 1
1 Laboratoire de pharmacologie-toxicologie, centre régional de pharmacovigilance, Angers, France 
2 Centre anti-poison, Angers, France 

Résumé

Introduction

T61® is a mixture of three compounds (embutramide 200mg/ml, mebezonium iodide 50mg/ml and tetracaine 5mg/ml) solubilised in N, N-dimethylformamide and commonly used for euthanasia of animals because of its narcotic and curariform-like activities. Unfortunately, T61® has been also involved in suicide or suicide attempts.

Case report

A mother, veterinary assistant, injected T61® by intravenous route to her 7-year old child, together with ketamine (Clorketam®). She also explained that then she administered by herself T61® by oral and/or intramuscular route(s). A neighbour found the mother into status of epilepticus and the child presenting a cardiac-respiratory arrest. They were admitted to the emergency department of Angers's hospital 6-hours later and blood samples were collected.

Material and method

Chromatographic analyses (LC-UV/DAD and GC-MS) were performed on blood samples and a liquid contained in the bottle found near the bodies.

Results

Plasma embutramide concentrations were 2,5mg/L for the mother and 5,0mg/L for the child. Ketamine and norketamine were also found, in the blood of the child at 0.55 and 0,9mg/L, respectively. The liquid contained embutramide (160mg/L) and tetracaine, which is consistent with the hypothesis of using T61®, even if mebezonium was not visible with our method. On the admission, the child presented a cerebral oedema, bilateral papillary mydriasis fixed to light, lactic acidosis, then she was brain dead 10h later. The mother waked out from the coma and the administration of N-acetylcysteine was continued to counteract the hepatic side effects of N, N-dimethylformamide as she presented cytolytic hepatits (PT of 29%) 3 days after her admission.

Discussion-conclusion

Eight fatal case-reports were described, mainly after intravenous injection of T61® (or Tanax®) and the postmortem blood concentrations of embutramide were ranging from 3 to 90mg/L. Our case-report was the first described for a child, with a concentration of 5mg/L. The simultaneous presence of ketamine and embutramide associated with mebezonium could have contributed to her death. The mother survived probably because she would have administered T61® by extravascular route, hence lowering the drug exposition.

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© 2014  Elsevier Masson SAS. Tous droits réservés.
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Vol 26 - N° 2S

P. S24 - juin 2014 Retour au numéro
Article précédent Article précédent
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