In the name of God Department of Internal Medicine Shiraz E-Medical Journal Home | Contents of This Issue | Contact Us |Search SEMJ Suicide With Endosulfan A Case Report A. Raaiskarimi, M.D. Department of internal Medicine, SUMS Abstract: The case is a 17 year old girl, case of suicidal attempt by endosulfan, which had interactable convulsions and finally developed cardiac arrest. Endosulfan is a chlorinated insecticide that causes CNS hyperstimulation state. They are absorbed from GI, skin or respiratory tract and lead to nausea, vomiting, paresthesia, giddiness, convulsion, coma and respiratory failure. Hepatic, renal and myocardial toxicity, agranulocytosis, aplastic anemia and skin reaction have also been reported. Mortality and morbidity rates are high and there is no special treatment for this toxin. Supportive cares for these patients include decontamination of skin, gastric lavage, active charcoal, lidocaine for arrhythmia and treatment of status epilepticus. Case Report : A 17 years old teenage girl was brought to emergency room with cardiopulmonary arrest. She was cyanotic, pulseless with 5mm fixed pupils. She ingested a glass of endosulfan in a suicidal attempt one hour prior to arrest . Basic CPR was done for her and after 15 min she had BP:110/70 and PR: 140/min regular rapid and deep respiration. Due to intractable tonic-clonic convulsion, Diazepam , Phenytion and Phenobarbital were given. She was transferred to ICU for mechanical ventilation and supportive care. After 6 hours she developed cardiac arrest and didn't respond to CPR and the expired in less than 12 hours after ingestion of endosulfan. Discussion : Endosulfan is a chlorinated insecticide or organochlorines like linden and DDT. It's complete name is 1,4,5,6,7 Hexachloro8,9,10. Trinorborn - 5en -2,3 ylenebis methylene sulphite and is used in agriculture . Most organochlorines are stored indefinitely in human fat tissues and have estrogenic effect and enhance the risk of breast cancer. DDT & many of organochlorines have been banned or restricted by environmental protection agencies world wide .These insecticides produce symptoms consistent with CNS stimulation. They are absorbed from gastrointestinal and respiratory tracts and skin. Acute poisoning is usually accompanied with nausea , vomiting , paresthesia , giddines , convulsion , coma and respiratory failure. Hepatic , renal and myocardial toxicity , agranulocytosis , aplastic anemia and skin reaction have been reported. The first known survivor after endosulfan ingestion has been reported in 19888. Form 1969 till 2000 eleven cases with endosulfan poisoning were reported that survived after suicide. 3 cases had complete recovery and 8 cases survived with residual morbidity including neurologic and psychiatric complications and renal failure 3-10. All of the above cases and those who expired after poisoning had generalized tonicclonic convulsion . Management of endosulfan poisoning is supportive and there is no antidote for it 1. Supportive care include: 1- Decontamination of skin with soap and water . 2- Gastric lavage and activated charcoal. 3- Symptomatic treatment for CNS stimulation and classic therapy for status epilepticus. 4- Lidocaine for cardiac arrhythmia. Atropine and epinephrine should be avoided in organochlorine sensitized myocardium. Summary : Endosulfan is a very fatal poison that produces CNS stimulation and status epilepticus. There is no specific therapy for this poison and management of endosulfan poisoning is only supportive . References : 1. Clinical Management of poisoning and drug over dosage. Haddad , shannon , Winchester 3rd edition 1998; p: 841-842. 2. The complete drug reference. Martin dale , 32nd edition 1999; p:1403-1406. 3. 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Aleksandrowicz-DR: Endosulfan poisoning and chronic brain syndrome : Archtoxicol-1979;43:65-8. 10. Demeter-J, Heyndrickx-A, Timperman-J, letevere-M, De-Beer-J: Toxicological analysis in a case of endosulfan suicide . Bull-Environ-Contam-Toxicol-1997;18.1104. Best viewed by Internet Explorer 4.0 ( or higher) with 600 X 800 resolution. Copyright © 2000 by Shiraz University of Medical Sciences, Department of Internal Medicine. All rights reserved. Mahmood Beheshti, M.D.