Acute Endosulfan Poisoning with Cerebral Edema and Cardiac Failure

Abstract

Endosulfan is a highly toxic organochlorine insecticide that produces well-known neurological symptoms of tonic-clonic convulsions, headache, dizziness and ataxia but also can cause gastrointestinal symptoms and metabolic disturbances. Life-threatening cerebral edema and hemodynamic instability may occur. Treatment is symptomatic and supportive.

Endosulfan Poisoning with Intravascular Hemolysis

“…Endosulfan acts as an antagonist to the inhibitory neurotransmitter Gama-aminobutyric acid (GABA) by inactivating GABA A-dependent chloride channels. Several cases of suicidal and accidental poisoning, as well as chronic poisoning, with endosulfan have been reported in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Poisoning with endosulfan produces strong sulfur odors, and the clinical picture is comprised of three stages: the acute cardiac and convulsive stage, followed by the sub-acute pulmonary and convulsive stage, and finally, the slow recovery stage (2).…”

Environmental Toxins and the Heart

“…274 The clinical manifestations of endosulfan toxicity include rhabdomyolysis, anion gap metabolic acidosis, acute kidney injury, altered mental status, hypotension, cerebral edema, and seizures. 274,275 The cardiac manifestations include myocardial infarction, ventricular systolic dysfunction (that may show recovery during convalescence), ventricular fibrillation, and death. 274,275 Electrocardiographic manifestations include premature beats, QTc interval prolongation, ST segment abnormalities, sinus tachycardia, atrial fibrillation, atrioventricular block, and ventricular fibrillation.…”

“…274,275 The cardiac manifestations include myocardial infarction, ventricular systolic dysfunction (that may show recovery during convalescence), ventricular fibrillation, and death. 274,275 Electrocardiographic manifestations include premature beats, QTc interval prolongation, ST segment abnormalities, sinus tachycardia, atrial fibrillation, atrioventricular block, and ventricular fibrillation. 274,275 Chromatographic analysis of serum, urine, and tissue specimens may confirm the ingestion of endosulfan.…”

“…274,275 Electrocardiographic manifestations include premature beats, QTc interval prolongation, ST segment abnormalities, sinus tachycardia, atrial fibrillation, atrioventricular block, and ventricular fibrillation. 274,275 Chromatographic analysis of serum, urine, and tissue specimens may confirm the ingestion of endosulfan. 274 No specific antidote to its toxicity exists; gastric lavage with activated charcoal and supportive care are advised.…”

Endosülfan ile Kasten Zehirleme İki Olgu

“…Ayr›ca yap›lan birçok çal›flmada endosülfan zehirlenmesinin temel olarak k›rsal bölgelerde görüldü¤ü, ço¤un-lukla kaza sonucu daha nadir olarak da intihar amaçl› toksikasyonlara rastland›¤› belirtilmektedir (10)(11)(12)(13)(14)(15). Olgular›m›zda endosülfan›n içilen sütlerin içinde tespit edilmesi kaza ya da intihar olas›l›¤›ndan uzaklaflt›rmak-tad›r.…”