(L)-alpha-terpineol

L-FORM IS FOUND IN SATUREIA MONTANA, LAVANDIN, CAJEPUT, LIME, LEMON, CINNAMON LEAVES, & DISTILLATES FROM PINACEAE (WITH THE EXCEPTION OF PINUS SILVESTRIS, WHICH CONTAINS D-TERPINEOL TOGETHER WITH THE RACEMIC FORM); LIKEWISE, NECTANDRA ELAIOPHORA (WOOD) & PETITGRAIN BIGARADE. /L-ISOMER/

/HUMAN EXPOSURE STUDIES/ ...Terpineols are irritating to eyes and mucous membranes. Produce hemorrhagic gastritis when ingested. Systemic effects incl weakness and central nervous depression, with hypothermia and resp failure. /Terpineols/

/CASE REPORTS/ The case history and toxicological findings of a fatal PineSol intoxication are presented. An 89-yr-old white female with Alzheimer's disease accidentally drank PineSol and was subsequently brought to the hospital where she was pronounced dead on arrival. Significant autopsy findings included acute erosive gastritis. There appeared to be no aspiration of PineSol into the lungs. Isopropanol along with 1-alpha-terpineol are the two major toxic ingredients of PineSol. ...Postmortem blood, urine, and gastric levels of 1-alpha-terpineol were 11.2 mg/l, 5.76 mg/l, and 15.3 g/l, respectively. Postmortem blood, vitreous humor, urine, and gastric acetone concns were 25, 31, 33, and 28 mg/dl. Postmortem concns of isopropanol were <10 mg/dl in the blood, vitreous humor, urine, and gastric contents. The cause of death was ruled acute 1-alpha-terpineol intoxication due to accidental ingestion of PineSol, presumably caused by confusion related to Alzheimer's disease.

Basic treatment: Establish a patent airway. Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if necessary. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Anticipate seizures and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with normal saline during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 ml/kg up to 200 ml of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool. /Turpentine, terpenes, and related compounds/

Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious or in respiratory arrest. Positive pressure ventilation techniques with a bag-valve-mask device may be beneficial. Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start an IV with D5W /SRP: "To keep open", minimal flow rate/. Use lactated Ringer's if signs of hypovolemia are present. Watch for signs of fluid overload. Consider drug therapy for pulmonary edema ... . Treat seizures with diazepam (Valium) ... . Use proparacaine hydrochloride to assist eye irrigation ... . /Turpentine, Terpenes, and related compounds/