To the Editor.—
In the April 1975 issue of the Archives (32:209, 1975), Allen et al describe a number of cases of a toxic polyneuropathy occurring among workers in a plastics plant. Their extensive investigations showed that the causative agent was methyl n-butyl ketone (MBK), with methyl ethyl ketone (MEK) possibly having a synergistic role.The neurotoxic effects of MBK and MEK assume even wider importance when one recalls that patients with ketotic hyperglycinemia1 and methylmalonic acidemia2 excrete large amounts of both substances. While a peripheral polyneuropathy is not an obvious clinical feature of either condition, its presence could well be overshadowed by the more striking neurological deficits in those children (mental retardation, changes in consciousness, extrapyramidal symptoms); to my knowledge, electromyography, nerve conduction velocities, or nerve biopsies have not been performed. In the light of the investigation of Allen et al, it would not be surprising if
Menkes JH. Toxic Polyneuropathy Due to Methyl n-Butyl Ketone. Arch Neurol. 1976;33(4):309. doi:10.1001/archneur.1976.00500040093028
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