Acute Tubular Necrosis Following Endosulphan Insecticide Poisoning

Abstract

Endosulphan is a chlorinated hydrocarbon insecticide with potential toxicity for the respiratory and central nervous systems. Renal toxicity has been rarely reported. We describe a man who developed renal failure due to acute tubular necrosis following a suicidal attempt with endosulphan in the absence of significant hypotension or sepsis.

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).…”

“…Acute poisoning is usually accompanied with nausea, vomiting, parasthesia, giddiness, convulsion, coma, respiratory failure, and congestive cardiac failure. Hepatic, renal, and myocardial toxicity, agranulocytosis, aplastic anemia, cerebral edema, pulmonary edema, thrombocytopenia, metabolic disturbances such as metabolic acidosis and skin reaction also have been reported (3)(4)(5)(6)(7)(8)11). Other features that can hint toward a possible endosulfan poisoning include sulfur odor and an abdominal X-ray demonstrating radio-opacity due to the chlorine component (11).…”

“…Common causes of death include pulmonary aspiration, myocardial insufficiency, pulmonary edema, and multi-organ failure. Residual psychiatric and neurological symptoms and renal failure have been reported in the survivors after exposure to either acute or chronic overdose of endosulfan (4,9,10). Management of endosulfan poisoning is mainly supportive and there is no antidote for it.…”

Development of anin vitro blood–brain barrier model to study the effects of endosulfan on the permeability of tight junctions and a comparative study of the cytotoxic effects of endosulfan on rat and human glial and neuronal cell cultures

“…It is also used as a wood preservative [Agency for Toxic Substances and Disease Registry (ATSDR), 2000]. Endosulfan residues have been detected in rat brains treated with endosulfan (Gupta, 1978;Ansari et al, 1984;Dikshith et al, 1984;Nath et al, 1978;Chan et al, 2005) and in humans (Demeter et al, 1977;Aleksandrowicz, 1979;Blanco-Coronado et al, 1992;Boereboom et al, 1998;Brandt et al, 2001;Chan et al, 2004;Eyer et al, 2004;Lo et al, 1995).…”

Pathology of Endosulfan

“…Postmortem finding included bilateral pleural effusions, hyaline membranes, microatelectasia, polymorphonuclear lymphocytes and red cells in the alveoli, and interstitial fibrosis also reported (Blanco-Coronado et al, 1992). Cardiorespiratory arrest was described in endosulfan poisoning in human (Lo et al, 1995;Yildiz et al, 2008).…”