A case of severe benzalkonium chloride intoxication in a cat

Abstract

Background: Benzalkonium chloride (BAC) is a quaternary ammonium compound (QAC), that can be found in a wide variety of household products-from disinfectants to medicaments and home fragrances-but also professional products. In pets, cats have long been reported as more sensitive than dogs to QACs; in fact, signs of irritation such as oral ulcerations, stomatitis and pharyngitis can be observed after contact with concentrations of 2% or lower. In a review of 245 cases of BAC exposure in cats, reported by the Veterinary Poisons Information Service (United Kingdom) only 1.2% of the cases died or were euthanized. Nevertheless, BAC toxidromes in cats can result in transitory CNS and respiratory distress, as well as severe mucosal and cutaneous lesions. Currently, only a few reports are available concerning BAC poisoning in this species.

Case presentation: A 4 month-old kitten presented with severe glossitis, lameness in the hindlimbs and episodes of vomiting and diarrhoea. The cause was unknown until the owners reported use of a BAC-containing mould remover (5%) 4 days later. The patient developed severe oral burns requiring a pharyngeal tube for feeding and severe cutaneous chemical burns. The kitten was managed with supportive therapy and required hospitalization for 10 days. The symptoms disappeared completely 3 weeks after exposure.

Conclusions: BAC is a very common compound contained in several household and professional products but, to the best of our knowledge, no previous case had been reported in Italy. We hope that this report will help raise awareness on the hazards of BAC products for cats in both domestic and work contexts.

Keywords: BAC; Benzalkonium chloride; Feline; Oral ulcerations; QAC; Toxidrome.

Fig. 1

BAC chemical structure, alkyl dimethyl benzyl ammonium chloride, CAS number 68424–85-1 https://commons.wikimedia.org/w/index.php?curid=29727055

Fig. 2

Lesions observed on the patient. A Enlargement of the tongue. B Chemical burns observed on the tongue. C Cutaneous irritation and excessive grooming of the hindlimb. D Chemical burns on the tongue and palate