Abstract
Dimethyl sulfate (DMS) is a highly toxic chemical that appears innocuous and is commonly used as a methylating agent in industry. It can be readily absorbed leading to poisoning or death through the skin or mucous membranes of the respiratory tract in the process of production or transportation. Although there are some articles on treatment for DMS poisoning, reports of death resulting from acute fatal DMS poisoning are very rare. Here, we present a case of a 50-year-old Chinese man who died accidentally from DMS poisoning after he broke a plastic storage tank full of DMS during transportation. The patient complained of eye irritation. In addition, the corrosive damage could be seen in his corneas and skin. The autopsy revealed erosions and ulcers in the respiratory tract, as well as massive congestion, necrosis, edema, and pseudomembrane formation on the mucous layer of the trachea and main bronchi. Histopathological examination confirmed extensive pulmonary edema, multifocal hemorrhages, whole-cell swelling in the brain, as well as disintegration of the neuronal cell. We inferred that DMS poisoning caused the symptoms resulting from the production of methanol and sulfate through hydrolysis, including respiratory toxicity and neurotoxicity, and these symptoms had temporal continuity. Toxicological analysis revealed no DMS or methanol, but formic acid was detected in the brain, both qualitatively and quantitatively. In this report, we also present a retrospective study of 8 similar cases of DMS poisoning in literature in China, including some clinical data and autopsy information.
Similar content being viewed by others
Data availability
The authors confirm that all data are included in the manuscript and its supplementary materials.
References
Wang Y, Xia J, Wang QW. Clinical report on 62 cases of acute dimethyl sulfate intoxication. Am J Ind Med. 1988;13(4):455–62. https://doi.org/10.1002/ajim.4700130405. PMID: 3364423.
Cartwright IL, Kelly SE. Probing the nature of chromosomal DNA-protein contacts by in vivo footprinting. Biotechniques. 1991;11(2):188–90, 192–4, 196 passim. PMID: 1931017.
Dimethyl sulfate. IARC monogr eval carcinog risks hum. 1999;71 Pt 2(PT 2):575–88. PMID: 10476462; PMCID: PMC7681375.
Schettgen T, Broding HC, Angerer J, Drexler H. Dimethyl sulphate; a hidden problem in occupational medicine. Occup Environ Med. 2004;61(1):73–5. PMID: 14691276; PMCID: PMC1757814.
Rippey JC, Stallwood MI. Nine cases of accidental exposure to dimethyl sulphate–a potential chemical weapon. Emerg Med J. 2005;22(12):878–9. https://doi.org/10.1136/emj.2004.015800.PMID:16299199;PMCID:PMC1726642.
Pharmacopoeia of the People's Republic of China, Beijing. 2020, ISBN:9787506700778.
Mathison BH, Taylor ML, Bogdanffy MS. Dimethyl sulfate uptake and methylation of DNA in rat respiratory tissues following acute inhalation. Fundam Appl Toxicol. 1995;28(2):255–63. https://doi.org/10.1006/faat.1995.1166. PMID: 8835235.
Tian M, He H, Liu Y, Li R, Zhu B, Cao Z. Fatal methanol poisoning with different clinical and autopsy findings: case report and literature review. Leg med (Tokyo). 2022;54. https://doi.org/10.1016/j.legalmed.2021.101995. Epub 2021 Nov 19 PMID: 34844153.
Tephly TR. The toxicity of methanol. Life Sci. 1991;48(11):1031–41. https://doi.org/10.1016/0024-3205(91)90504-5. PMID: 1997785.
Roock SD, Deleuze JP, Rose T, Jennes S, Hantson P. Severe metabolic acidosis following assault chemical burn. J Emerg Trauma Shock. 2012;5(2):178–80. https://doi.org/10.4103/0974-2700.96488. PMID:22787349; PMCID:PMC3391843.
Dinis-Oliveira RJ, Carvalho F, Moreira R, Proença JB, Santos A, Duarte JA, Bastos Mde L, Magalhães T. Clinical and forensic signs related to chemical burns: a mechanistic approach. Burns. 2015;41(4):658–79. https://doi.org/10.1016/j.burns.2014.09.002. Epub 2014 Oct 1 PMID: 25280586.
Zhang X, Wang Z, Tang X, Wang Z. An accidental exposure to dimethyl sulfate. Clin toxicol (Phila). 2019;57(8):748–9. https://doi.org/10.1080/15563650.2018.1547827. Epub 2019 Jan 24 PMID: 30676823.
Bakand S, Winder C, Khalil C, Hayes A. Toxicity assessment of industrial chemicals and airborne contaminants: transition from in vivo to in vitro test methods: a review. Inhal toxicol. 2005;17(13):775–87. https://doi.org/10.1080/08958370500225240. PMID: 16195213.
Littler TR, McConnell RB. Dimethyl sulphate poisoning. Br J Ind Med. 1955;12(1):54–6. https://doi.org/10.1136/oem.12.1.54. PMID: 14351647; PMCID: PMC1037601.
Siegel D, Younggren BN, Ness B, Kvool V. Operation castle cascade: managing multiple casualties from a simulated chemical weapons attack. Mil Med. 2003;168(5):351–4 PMID: 12775167.
Na J, Wei M, Chen S. A fatal case of acute dimethyl sulfate poisoning. Railway Med J. 1978;05:279–80.
Huang P, Yang M. Report on fatal cases of severe dimethyl sulfate poisoning. Occup Med. 1994;02:38.
Luo Z, Dai Q. Investigation and analysis of a misdiagnosed death due to dimethyl sulfate poisoning. J Labour Med. 1990;04:31–2. https://doi.org/10.13213/j.cnki.jeom.1990.04.018.
Huang P, Yang M, Chen C. Discussion of two fatal cases involving acute dimethyl sulfate poisoning and chemical burns. Chem Ind Occupational Safety Health. 1993;05:202–4.
Bian S, Sun Z, Zhuang Q. Analysis of the cause of death of two individuals due to the combined effect of multiple toxic gases. Chinese J Forensic Med. 1997;04:242–3. https://doi.org/10.13618/j.issn.1001-5728.1997.04.020.
Wang H, Deng W, Cai X. Forensic examination of six cases of death from acute poisoning by irritant gases. J Forensic Med. 2011;27(06):473–475. https://doi.org/10.3969/j.issn.1004-5619.2011.06.025.
Author information
Authors and Affiliations
Contributions
Jie Zhang performed the data analyses and wrote the manuscript; Xiaowei Zhou contributed significantly to the analysis and manuscript preparation; Jinghong Ma performed the toxicological analysis; Liang Ren contributed to the conception of the study; Liang Liu helped perform the analysis with constructive discussions.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
Informed consent was obtained from all the participants prior to the enrollment of this case report.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zhang, J., Zhou, X., Ma, J. et al. Dimethyl sulfate poisoning in China: a fatal case and a 45-year retrospective study. Forensic Sci Med Pathol (2023). https://doi.org/10.1007/s12024-023-00740-0
Accepted:
Published:
DOI: https://doi.org/10.1007/s12024-023-00740-0