Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Clinical Analysis of Acute Endosulfan Poisoning: Single Center Experience

급성 엔도설판 중독의 임상적 고찰

  • Kim, So Eun (Department of Emergency Medicine, Medical School, Chonbuk National University) ;
  • Kim, Su Ik (Department of Emergency Medicine, Presbyterian Medical Center) ;
  • Lee, Jae Baek (Department of Emergency Medicine, Medical School, Chonbuk National University) ;
  • Jin, Young Ho (Department of Emergency Medicine, Medical School, Chonbuk National University) ;
  • Jeong, Tae Oh (Department of Emergency Medicine, Medical School, Chonbuk National University) ;
  • Jo, Si On (Department of Emergency Medicine, Medical School, Chonbuk National University) ;
  • Yoon, Jae Chol (Department of Emergency Medicine, Medical School, Chonbuk National University)
  • 김소은 (전북대학교 의학전문대학원 응급의학교실) ;
  • 김수익 (전주예수병원 응급의학과) ;
  • 이재백 (전북대학교 의학전문대학원 응급의학교실) ;
  • 진영호 (전북대학교 의학전문대학원 응급의학교실) ;
  • 정태오 (전북대학교 의학전문대학원 응급의학교실) ;
  • 조시온 (전북대학교 의학전문대학원 응급의학교실) ;
  • 윤재철 (전북대학교 의학전문대학원 응급의학교실)
  • Received : 2015.06.16
  • Accepted : 2015.07.22
  • Published : 2015.12.31
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Abstract

Purpose: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. Methods: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. Results: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. Conclusion: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.

Keywords

References

  1. Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank's toxicologic emergencies. 9th ed. New York:McGraw-Hill; 2011. P.1477-93.
  2. Availlable from: http://www.law.go.kr/admRulSc.do?menuId=1&query=%EB%86%8D%EC%95%BD%EC%9D%98%20%EC%88%98%EC%B6%9C%EC%9E%85#liBgcolor0.
  3. Han BG, Lee JH, Lee KW. Effect of Seizure on Prognosis in Acute Endosulfan Intoxication. J Korean Soc Clin Toxicol 2009;7:77-82.
  4. Moon JM, Chun BJ. Acute endosulfan poisoning: a retrospective study. Hum Exp Toxicol 2009;28:309-16. https://doi.org/10.1177/0960327109106488
  5. Moses V, Peter JV. Acute intentional toxicity: endosulfan and other organochlorines. Clin Toxicol (Phila) 2010;48:539-44. https://doi.org/10.3109/15563650.2010.494610
  6. Kim SI, Kang JH, Lee DI, Jo JR, Kim HJ, Lee JB, et al. Measurement of Volume of a Swallow for Liquid Swallowing in Healthy Young Adults. J Korean Soc Clin Toxicol 2013;11:114-8.
  7. Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012;17:3-23. https://doi.org/10.1007/s12028-012-9695-z
  8. Vale C, Fonfria E, Bujons J, Messeguer A, Rodriguez-Farre E, Sunol C. The organochlorine pesticides gammahexachlorocyclohexane (lindane), alpha-endosulfan and dieldrin differentially interact with GABA (A) and glycine-gated chloride channels in primary cultures of cerebellar granule cells. Neuroscience 2003;117:397-403. https://doi.org/10.1016/S0306-4522(02)00875-8
  9. Eyer F, Felgenhauer N, Jetzinger E, Pfab R, Zilker TR. Acute endosulfan poisoning with cerebral edema and cardiac failure. J Toxicol Clin Toxicol 2004;42:927-32. https://doi.org/10.1081/CLT-200035456
  10. Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 1994;35:27-34. https://doi.org/10.1111/j.1528-1157.1994.tb02908.x
  11. Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study. Epilepsia 2010;51:251-6. https://doi.org/10.1111/j.1528-1167.2009.02323.x
  12. Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia 1993;34 Suppl 1:S54-8. https://doi.org/10.1111/j.1528-1157.1993.tb05906.x
  13. Fountain NB. Status epilepticus: risk factors and complications. Epilepsia 2000;41 Suppl 2:S23-30. https://doi.org/10.1111/j.1528-1157.2000.tb01521.x
  14. Fujikawa DG, Itabashi HH, Wu A, Shinmei SS. Status epilepticus-induced neuronal loss in humans without systemic complications or epilepsy. Epilepsia 2000;41:981-91. https://doi.org/10.1111/j.1528-1157.2000.tb00283.x
  15. Bassin S, Smith TL, Bleck TP. Clinical review: status epilepticus. Crit Care 2002;6:137-42. https://doi.org/10.1186/cc1472
  16. Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol 2006;5:246-56. https://doi.org/10.1016/S1474-4422(06)70374-X
  17. Naylor DE, Liu H, Wasterlain CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosci 2005;25:7724-33. https://doi.org/10.1523/JNEUROSCI.4944-04.2005
  18. Kalender S, Kalender Y, Ogutcu A, Uzunhisarcikli M, Durak D, Acikgoz F. Endosulfan-induced cardiotoxicity and free radical metabolism in rats: the protective effect of vitamin E. Toxicology 2004;202:227-35. https://doi.org/10.1016/j.tox.2004.05.010
  19. Blanco-Coronado JL, Repetto M, Ginestal RJ, Vicente JR, Yelamos F, Lardelli A. Acute intoxication by endosulfan. J Toxicol Clin Toxicol 1992;30:575-83. https://doi.org/10.3109/15563659209017943
  20. Ozmen O, Sahinduran S, Mor F. Pathological and immunohistochemical examinations of the pancreas in subacute endosulfan toxicity in rabbits. Pancreas 2010;39:367-70. https://doi.org/10.1097/MPA.0b013e3181bd95d6
  21. Lee SJ, Jang HY, Eo EK, Jung KY. Two cases of acute intoxication of endosulfan. J Korean Soc Clin Toxicol 2003;1:47-50.
  22. Boereboom FT, van Dijk A, van Zoonen P, Meulenbelt J. Nonaccidental endosulfan intoxication: a case report with toxicokinetic calculations and tissue concentrations. J Toxicol Clin Toxicol 1998;36:345-52. https://doi.org/10.3109/15563659809028031
  23. Moon HJ, Lee JW. Availability of intravenous lipid emulsion therapy on endosulfan-induced cardiovascular collapse. Am J Emerg Med 2013;31:886.e1-2.