Clinical Features of Acute Endosulfan Intoxication: A study of 15 cases

Lee, Jin Ho; Jin, Young Ho; Jeong, Tae Oh; Lee, Jae Baek; Kang, Ji Hun

Abstract

PURPOSE: The unrestricted use of endosulfan results in many cases of intentional and unintentional poisoning, mainly in developing countries. We report our experience with the clinical features of endosulfan poisoning.
METHODS
Fifteen patients with endosulfan exposure who came to our emergency department (ED) during the study period were retrospectively enrolled. Toxicological history, toxic symptoms and signs, and laboratory test results were collected from the ED medical records. The patients were classified into two groups according to the presence or absence of seizures. The quantitative data and dichotomous variables were compared between the two groups.
RESULTS
The 15 patients, 9 women and 6 men, had a mean age of 54.7 years. Most of the poisonings (13 patients, 86.7%) stemmed from deliberate self-harm, while the other two were unintentional. The patients were categorized into seizure (10 patients) and no-seizure (5) groups. After the acute phase of toxicity, complications were observed in 9 patients and all of them belonged to the seizure group. Eight patients in the seizure group progressed to status epilepticus and needed mechanical ventilatory support. Four of these patients (50%) subsequently died. The duration of hospital stay was 8.5 days in the seizure group and 3.0 days in the no-seizure group. White blood cell counts, blood glucose, and enzyme function tests for the liver, pancreas, heart, and muscles were abnormally increased in the seizure group, all occurring within the initial 24 hours after the onset of seizure. Severe metabolic acidosis was also present in the seizure group.
CONCLUSION
Seizure or status epilepticus accompanied by involvement of several organs was distinctive feature of endosulfan exposure/poisoning. Therefore, emergency physicians who practice in agricultural areas should have a high index of suspicion when treating patients presenting with acute repetitive seizure, accompanied by gastrointestinal complaints and laboratory evidence of multiple organ dysfunction including metabolic acidosis.