Prognostic Predictors of Endosulfan Intoxication

Moon, Jae Woong; Moon, Jeong Mi; Lee, Byong Kook; Roo, Hyun Ho

Abstract

PURPOSE: Although endosulfan is a highly toxic compound that is responsible for a number of severe intoxications and deaths, there are no specific antidotes for endosulfan poisoning. Most fatalities due to endosulfan ingestion have symptoms that develop within 4~6 hours after ingestion, and to improve survival chances it is important to recognize those patients with a poor prognosis as early as possible and to institute aggressive treatment. Therefore we sought to identify the factors that predict death in patients with endosulfan ingestion.
METHODS
We enrolled 58 patients who were over 18 years and who presented to Chonnam National University Hospital with ingestion of endosulfan from January 2001 to June 2007. These patients were divided into two groups according to survival. The baseline characteristics, initial results of laboratory tests, the occurrence of complications, and the duration of hospitalization were collected.
RESULTS
The fatality rate of endosulfan was 30.2%. The most common cause of death in the non-survival group was refractory status epilepticus. The patients in the non-survival group showed significantly lower blood pressure, arterial pH, base excess, and bicarbonate, and a significantly higher level of arterial carbon dioxide, sodium, and potassium than the survival group. In a multivariate analysis, the independent factors were arterial pH and the amount ingested.
CONCLUSION
Endosulfan is a highly harmful pesticide with a fatality rate over 30%. The factors that predict death during hospitalization are arterial pH on admission and amount ingested. The physician must start an aggressive treatment, including early administration of the appropriate anticonvulsant, when a patient presents to the ER with these characteristics.