I had an interesting handover a few weeks ago. After the initial steaming pile of handover patients, my colleague gave me this:
This is Ms. S, one of our regular alcoholic patients. She is intoxicated, as normal, but today she has bruises all over her body. When I did some labwork, her platelets came back at 8! I have no idea why she is acutely thrombocytopenic.
My first question was, “Was she drinking hairspray?”
He looked over his horn-rimmed glasses at me, “Yes, she had a big bottle of it with her. How the fuck did you know that?”
I did my training on the Canadian Praries, and Hairspray is one of the favorite OTC intoxicants there. His question stopped me in my tracks… I just assumed that this was one of the many toxicological minutiae I had forgotten since I wrote my EM exams, but a quick Google Search brought up nothing useful, and my colleagues had never heard of this connection, so my search went deeper.
[Aside: the local OTC intoxicant in Vancouver is mouthwash. It has few toxicological concerns beyond the ethanol in it, and has the bonus side effect of making the patient smell cleanish if not downright refreshing.]
‘Hairspray’ does not have a single chemical composition, and can contain a variety of fun and interesting substances. These range from relatively innocuous to downright scary from a toxicological perspective. The most likely culprits that I could find were the copolymers (the bits that make your hair stand up straight), and particularly a variety of esters of Poly methyl vinyl ether/Maleic Acid copolymers (PVM/MA).
The chief target organ is the hematopoietic system. Bleeding from the nose, gums, or mucous membranes and the development of purpuric spots, pancytopenia, leukopenia, thrombocytopenia, aplastic anemia, and leukemia may occur as the condition progresses.
So, nasty. While this stuff is present in small amounts in hairspray, it was never meant for ingestion.
There may be other culprit substances, and I would invite the toxicologists out there to chime in, correct and/or chastise me as you see fit.
Bottom line – if your intoxicated patients are thrombocytopenic ask them if they have been drinking anything new.