Fatal intravenous injection of monooctanoin

Monooctanoin, a hydrophobic solvent, is used clinically to dissolve gallstones via intrabiliary infusion. We report a therapeutic misadventure in which an intravenous injection of the drug resulted in respiratory and cardiac arrest and death. Autopsy findings included pulmonary lipid embolization, detection of monooctanoin in the lung parenchyma, and histopathological evidence of multifocal pulmonary hemorrhagic infarcts. Respiratory compromise has been observed in the standard treatment of patients. In addition, deaths in laboratory animals have been attributed to hemorrhagic pneumonitis. This case illustrates the potential adverse effects of the inappropriate administration of monooctanoin.