Acute intentional toxicity: endosulfan and other organochlorines

Abstract

Introduction. Organochlorine pesticides continue to be used in several developing countries despite concerns regarding their toxicity profile. Endosulfan is an organochlorine recognized as an important agent of acute toxicity. Methods. In this retrospective study, the clinical features, course, and outcomes among patients with acute endosulfan poisoning requiring admission to the hospital during an 8-year period (1999–2007) were reviewed. Results. Among 34 patients hospitalized during this study period for alleged organochlorine poisoning, 16 patients with endosulfan poisoning were identified. The majority (75%) received initial treatment at a primary or secondary center. Neurological toxicity predominated, particularly low sensorium (81%) and generalized seizures (75%), including status epilepticus (33%). Other features observed included hepatic transaminase elevation, azotemia, metabolic acidosis, and leukocytosis. Mechanical ventilation was required in 69% and vasoactive agents in 19%. In-hospital mortality was 19%. There were no gross neurological sequelae at discharge. In three other patients who presented with organochlorine poisoning, the compounds ingested were lindane, endrin, and dicofol (n = 1 each). The course and outcomes in these patients were unremarkable and all three patients survived. Conclusions. Endosulfan is capable of high lethality and significant morbidity. The commonest manifestations are neurological although other organ dysfunction also occurs. In the absence of effective antidotes, restriction of its availability, along with prompt treatment of toxicity, including preemptive anticonvulsant therapy are suggested.

Keywords:

• Mortality
• Pesticide
• Seizure
• Organ failure

Acknowledgements

We are grateful to the heads of units of the Department of Medicine, Dr OC Abraham, Dr K Thomas, and Dr P Mathews for permitting the review of patient records necessary for this work.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.