A patient with ethylthiometon poisoning in whom the dosage form possibly contributed to protracted central respiratory depression

We report a patient who took a strongly toxic organic phosphorus preparation, ethylthiometon granules, to commit suicide, leading to protracted central respiratory depression, in which the dosage form may have been etiologically involved. The patient was a 56-year-old female. She took approximately 75 g of 5% ethylthiometon granules at home, and was admitted to our hospital. As respiratory depression was observed, endotracheal intubation was per-formed. Subsequently, gastric lavage was conducted. In addition, activated carbon was used for decontamination. As an antagonist, atropine was used. Stable spontaneous respiration could not be achieved for 1 month. Ventilator-de-pendent central respiratory depression was protracted. The ventilator was weaned off 34 days after admission. Based on previous case reports on ethylthiometon poisoning, the protracted respiratory depression in the present case was possibly associated with granules strongly adhering to the stomach. For organic phosphorus poisoning, treatment and management must be performed, considering the dosage form. In particular, granules may strongly adhere to the gastric wall. It may be necessary to perform upper digestive tract endoscopy in the early stage and decontamination of the digestive tract under direct vision. Furthermore, it may be necessary to perform repetitive gastric and intestinal lavage with charcoal.