A case of accidental ingestion, a first of its kind – A 54-year-old mistakenly drinks Octane Booster Racing Formula
Accidental ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) containing drink is quite a rare finding in clinical settings. A 54-year-old presented to the emergency department with an altered level of consciousness and seizure. The symptoms began after he accidentally ingested 12 oz. of MMT-containing NOS Octane Booster Racing Formula, which is a car-fuel additive.
The patient mistook the racing formula for NOS High-Performance energy drink. This particular incident highlights the importance of label warnings and clearly visible and readable cautions and labels on such products.
NOS Octane Booster Racing Formula contains methylcyclopentadienyl manganese tricarbonyl (MMT). It is a manganese-containing organometallic compound with antiknock properties, therefore, people use it as a gasoline additive. Its toxicity after ingestion is quite rarely reported in humans (this was the first reported case), therefore, the knowledge of its toxic effects comes from the studies in rats/mice. Mice suffered neurotoxic effects such as seizures. Subsequently, MMT in mice resulted in pulmonary, liver, and renal toxicity too.
The patient’s condition warranted intubation as the seizures didn’t subside despite adequate management with benzodiazepines.
The doctors shifted him to the intensive care unit. In the ICU, the patient suffered further two episodes of seizures while intubated.
On the 4th post-ingestion day, the patient had shown improvement, therefore, the doctors extubated him. However, after extubation, the patient felt confused and ataxic.
One day after extubation, the symptoms subsided. His physicians discharged him without any further complications.
Besides highlighting the importance of labels, another noteworthy point from this case is the importance of reporting such incidents to the concerned authorities so actions can be taken to eliminate the confusing and similar-looking labels and packaging.
Nemanich A, Chen B, Valento M, Toxic boost: Acute, reversible neurotoxicity after ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) mistaken for an energy drink, Aug:31; 2020, DOI:https://doi.org/10.1016/j.ajem.2020.08.087
Fishman BE, McGinley PA, Gianutsos G. Neurotoxic effects of methylcyclopentadienyl manganese tricarbonyl (MMT) in the mouse: basis of MMT-induced seizure activity. Toxicology. 1987;45(2):193-201. doi:10.1016/0300-483x(87)90105-3