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14 September 2022 : Case report  Japan

[In Press] Metolachlor Poisoning with Lactic Acidosis Improved by Thiamine Administration: A Case Report

Unusual clinical course, Unusual or unexpected effect of treatment

Akira Suekane12ABCDE, Masato Edamoto3BCDEF, Keisuke Kubo42DEF, Tomohiro Abe ORCID logo42CDEF, Keita Nakatsutsumi ORCID logo1DEF, Tatsunori Ameda23DEF

DOI: 10.12659/AJCR.937873

Am J Case Rep In Press; DOI: 10.12659/AJCR.937873  

Available online: 2022-09-14, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Metolachlor is a chloroacetamide herbicide that is extensively used worldwide. Ingestion of metolachlor causes acute toxicity via the generation of methemoglobin. Elevated levels of methemoglobin inhibit the transport of oxygen to tissue, causing hypoxia and lactic acidosis. A common treatment approach has been to reduce methemoglobin by administration of methylene blue. Herein, we present a case of metolachlor poisoning causing lactic acidosis that was treatable by thiamine administration, in which the methemoglobin level was not elevated.
A 61-year-old man was admitted to the emergency room with seizures and impaired consciousness after the ingestion of metolachlor (250 mL, 83%) with the intent to commit suicide. The patient’s methemoglobin and lactate levels on admission were 0.9% and 11.8 mmol/L, respectively. After admission, the levels of lactate decreased gradually; however, they increased 13 h after admission. There was no evidence of heavy alcohol consumption, hyponutrition, or chronic thiamine deficiency. We initially administered a thiamine bolus (100 mg), which immediately improved his consciousness, followed by continuous administration of the same substance (1500 mg/day). The patient’s consciousness improved, and was discharged from the intensive care unit on day 4.
Metolachlor can cause metabolic dysfunction and lactic acidosis without an increase in methemoglobin. Moreover, thiamine administration may be beneficial for patients with metolachlor intoxication exhibiting symptoms of elevated lactate levels, impaired consciousness, and lack of elevated methemoglobin levels.

Keywords: Thiamine; Metolachlor


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923