A Man Drank Racing Formula, A Car Fuel Additive

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NOS racing formula and energy drink
Image Source: Summit Racing/ eBay

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.

Reference:

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

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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