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Endrin Poisoning

Endrin is a toxic chlorinated hydrocarbon that was formerly widely used as a pesticide and in various industries. It can enter the body through the gastrointestinal tract, skin or lungs. Endrin poisoning is typified by central nervous system dysregulation.


Presentation

Endrin is an organochlorine, a substance that has been used in pesticides and manufacturing plants [1]. Similar compounds include dieldrin and endosulfan [2] [3] [4]. Exposure is mainly either accidental or occupational and entails ingestion of contaminated food or water, absorption through the skin when in contact with contaminated soil for example, and inhalation of polluted air in industries. Symptoms usually resolve and patients fully recover after exposure has ceased, however, some cases of severe endrin poisoning (EP) are fatal.

Acute EP occurs unintentionally (although it can be deliberate), and mild exposure produces fewer complaints such as abdominal discomfort, headaches, and dizziness. Nausea and vomiting are also present. More severe signs are experienced with higher doses, this is exemplified by cardiac arrhythmias. As endrin mainly affects the central nervous system (CNS), multiple neurological disturbances can be noticed [5]. The most frequent of these is generalized tonic-clonic seizures. These may commence abruptly, with no prodromes, minutes to days after exposure [6]. They often recur over the course of a few days, and patients may exhibit episodes of altered mental status, such as confusion, and may be comatose. Repeated seizures contribute to fatalities by causing tissue hypoxia and acid-base derangement. Moreover, paresthesia, involuntary muscle movements, and gait instability have been reported [7]. Endrin can directly cause significant respiratory depression. Rarer manifestations such as hyperthermia have been described. Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks. Electroencephalogram (EEG) changes may be reported up to 6 months after the latest exposure [8]. Signs of chronic disease may include damage to the liver, lung, and kidneys.

Weakness
  • Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks. Electroencephalogram (EEG) changes may be reported up to 6 months after the latest exposure.[symptoma.com]
  • Symptoms of endrin poisoning include dizziness, nausea, tremors, leg weakness, disorientation, and tonic-clonic seizures (1).[cdc.gov]
  • Other negative side effects of endrin exposure include dizziness, headaches, hyperexcitable state, incoordination, mental confusion, nausea, tremor, vomiting, and weakness in the legs.[naturalpedia.com]
  • My weak memory wants to say it was Harrowmont, but I need some confirmation. If I remember correctly, Bhelen (youngest of three children of the old king) killed his eldest brother Trian, framed the middle brother/sister, and poisoned Daddy.[gamefaqs.com]
  • These workers experienced a constellation of clinical effects (sometimes still called the “Kepone shakes”), consisting of prolonged tremulousness, exaggerated startle responses, generalized weakness, oculomotor disturbances, ataxia, hepatitis, rash, weight[calpoison.org]
Hyperthermia
  • Rarer manifestations such as hyperthermia have been described. Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks.[symptoma.com]
  • External cooling may be used for hyperthermia. In all cases, consult with the regional poison control center for information regarding the specific ingestion.[emedicine.medscape.com]
Fatigue
  • Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks. Electroencephalogram (EEG) changes may be reported up to 6 months after the latest exposure.[symptoma.com]
  • Exposure Produces Health Symptoms Symptoms maybe short term or long term depending on the exposure duration and intensity and effects areas like Cardiovascular, Gastrointestinal, Cognition, Fatigue.[toxno.com.au]
Anorexia
  • Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks. Electroencephalogram (EEG) changes may be reported up to 6 months after the latest exposure.[symptoma.com]
  • الصفحة 11 - Anorexia, nausea, vomiting, abdominal cramps, epigastric and substernal tightness (cardiospasm) with "heartburn" and eructation, diarrhea, tenesmus, involuntary defecation. Increased sweating. Increased salivation.[books.google.com]
Fatigue
  • Some symptoms following acute intoxication, namely general body weakness, fatigue, dizziness, and anorexia, persist for a number of weeks. Electroencephalogram (EEG) changes may be reported up to 6 months after the latest exposure.[symptoma.com]
  • Exposure Produces Health Symptoms Symptoms maybe short term or long term depending on the exposure duration and intensity and effects areas like Cardiovascular, Gastrointestinal, Cognition, Fatigue.[toxno.com.au]
Nausea
  • Nausea and vomiting are also present. More severe signs are experienced with higher doses, this is exemplified by cardiac arrhythmias. As endrin mainly affects the central nervous system (CNS), multiple neurological disturbances can be noticed.[symptoma.com]
  • After the hospitalization, he had somnolence, muscular fibrillation, irritation, nausea and vomi tting and arrhythmia.[jstage.jst.go.jp]
  • الصفحة 11 - Anorexia, nausea, vomiting, abdominal cramps, epigastric and substernal tightness (cardiospasm) with "heartburn" and eructation, diarrhea, tenesmus, involuntary defecation. Increased sweating. Increased salivation.[books.google.com]
  • Symptoms of endrin poisoning include dizziness, nausea, tremors, leg weakness, disorientation, and tonic-clonic seizures (1).[cdc.gov]
Loss of Appetite
  • Other Effects Other effects that are observed in the medium or long term after exposure to POPs may include, loss of appetite, weight loss, nausea, headaches, sleep alterations, signs that numerous peripheral nerves are affected, liver and renal damage[bvsde.paho.org]
Food Poisoning
  • Outbreak of food-poisoning from bread made of chemically contaminated flour. Br Med J 1956;2:393-8. 3.Weeks DE. Endrin food-poisoning: a report on four outbreaks caused by two separate shipments of endrin-contaminated flour.[cdc.gov]
Abdominal Cramps
  • الصفحة 11 - Anorexia, nausea, vomiting, abdominal cramps, epigastric and substernal tightness (cardiospasm) with "heartburn" and eructation, diarrhea, tenesmus, involuntary defecation. Increased sweating. Increased salivation.[books.google.com]
Eructation
  • الصفحة 11 - Anorexia, nausea, vomiting, abdominal cramps, epigastric and substernal tightness (cardiospasm) with "heartburn" and eructation, diarrhea, tenesmus, involuntary defecation. Increased sweating. Increased salivation.[books.google.com]
Hypertension
  • Delivery Models Health Care Economics, Insurance, Payment Health Care Policy Health Care Quality Health Care Reform Health Care Safety Health Care Workforce Health Disparities Health Informatics Health Policy Hematology History of Medicine Humanities Hypertension[jamanetwork.com]
  • Results show that acute administration of endrin produces bradycardia, hypertension, copious salivation, tonic-clonic convulsions, increased body temperature, leukocytosis, hemoconcentrations and decreased blood pH.[rosap.ntl.bts.gov]
Tachycardia
  • Certain values may be deranged due to organ dysfunction that can be made evident by hypoxemia, metabolic acidosis, hyperkalemia, raised creatinine levels, tachycardia or bradycardia, and increased serum bilirubin.[symptoma.com]
Increased Sweating
  • Increased sweating. Increased salivation. Increased lacrimination. ‏[books.google.com]
Withdrawn
  • The registration of endrin for agricultural purposes in the United States was withdrawn in 1984 (5), and it has not been manufactured in this country since that time.[cdc.gov]
Seizure
  • The most frequent of these is generalized tonic-clonic seizures. These may commence abruptly, with no prodromes, minutes to days after exposure.[symptoma.com]
  • After the seizures in March, he had been diagnosed as epileptic and begun on long-term anticonvulsants.[cdc.gov]
  • ; odorless -Endrin (hexadrin), Canceled, highest acute oral toxicity, high dermal absorption, no lipid storage, most toxic organochlorine; rapid onset seizures; status epilepticus -Chlordane (octachlor, toxichlor, others), canceled, moderate acute oral[quizlet.com]
  • Extensive or repeated (as little as two applications on two successive days) whole-body application of lindane to infants has resulted in seizures and death. Clinical presentation.[accessmedicine.mhmedical.com]
  • As with other toxin-mediated seizures, phenytoin is usually ineffective for organochlorine-induced seizures. It is important to monitor for and recognize the dysrhythmogenic effects of organochlorine agents.[calpoison.org]
Confusion
  • They often recur over the course of a few days, and patients may exhibit episodes of altered mental status, such as confusion, and may be comatose. Repeated seizures contribute to fatalities by causing tissue hypoxia and acid-base derangement.[symptoma.com]
  • Shortly after acute ingestion, nausea and vomiting occur, followed by paresthesias of the tongue, lips, and face; confusion; tremor; obtundation; coma; seizures; and respiratory depression.[accessmedicine.mhmedical.com]
  • […] acute poisoning (usually due to exposure to large quantities in a very short time) include an increase in sensitivity and a tingling sensation in the face (especially peribuccal) and limbs, although giddiness, lack of coordination, tremor, and mental confusion[bvsde.paho.org]
  • Other negative side effects of endrin exposure include dizziness, headaches, hyperexcitable state, incoordination, mental confusion, nausea, tremor, vomiting, and weakness in the legs.[naturalpedia.com]
  • SOURCES: T3DB PubChem EPA in USA LAST UPDATE: 28/04/2018 Health Associations Mostly focused on Health Implications of Long Term Exposure to this substance SYMPTOMS: Symptoms that may result from endrin poisoning are headaches, dizziness, nervousness, confusion[toxno.com.au]
Dizziness
  • Acute EP occurs unintentionally (although it can be deliberate), and mild exposure produces fewer complaints such as abdominal discomfort, headaches, and dizziness. Nausea and vomiting are also present.[symptoma.com]
  • Symptoms of endrin poisoning include dizziness, nausea, tremors, leg weakness, disorientation, and tonic-clonic seizures (1).[cdc.gov]
  • Other negative side effects of endrin exposure include dizziness, headaches, hyperexcitable state, incoordination, mental confusion, nausea, tremor, vomiting, and weakness in the legs.[naturalpedia.com]
  • C12H8Cl6O DATA SOURCES: DATA SOURCES: T3DB PubChem EPA in USA LAST UPDATE: 28/04/2018 Health Associations Mostly focused on Health Implications of Long Term Exposure to this substance SYMPTOMS: Symptoms that may result from endrin poisoning are headaches, dizziness[toxno.com.au]
  • Endrin is also believed to cause birth defects. ( 1, 3 ) Symptoms Symptoms that may result from endrin poisoning are headaches, dizziness, nervousness, confusion, nausea, vomiting, and convulsions. ( 3 ) Treatment Treatment is symptomatic, aimed at controlling[contaminantdb.ca]
Neglect
  • Starvation and Neglect 173 Death by Electrocution 175 Deaths Associated with Surgery Anaesthesia and Blood Transfusion 183 Custody Related Torture andor Death 191 Medicolegal Considerations and Types 197 Injuries by Blunt Force 213 Injuries by Sharp Force[books.google.com]
  • Explore the possibility of child, elder, or vulnerable adult abuse or neglect.[emedicine.medscape.com]
Paresthesia
  • Moreover, paresthesia, involuntary muscle movements, and gait instability have been reported. Endrin can directly cause significant respiratory depression. Rarer manifestations such as hyperthermia have been described.[symptoma.com]
  • Shortly after acute ingestion, nausea and vomiting occur, followed by paresthesias of the tongue, lips, and face; confusion; tremor; obtundation; coma; seizures; and respiratory depression.[accessmedicine.mhmedical.com]
  • Clinical presentation The organochlorines most commonly stimulate the CNS, and symptoms can range from paresthesias to seizures. With large exposures and severe toxicity, status epilepticus with respiratory failure and death can ensue.[calpoison.org]

Workup

Diagnosis is clinical and formulated by both anamnestic data and physical examination. It should be noted that the patient history serves to inquire about endrin exposure and, in addition, it is a tool for excluding organic causes of CNS dysfunction. Ensuing studies should be conducted with the same aim if the history is unclear. These include a basic metabolic panel, arterial blood gases, toxicology screen, liver function tests, urine microscopy culture and sensitivity and blood glucose testing. Certain values may be deranged due to organ dysfunction that can be made evident by hypoxemia, metabolic acidosis, hyperkalemia, raised creatinine levels, tachycardia or bradycardia, and increased serum bilirubin. A head computerized tomography (CT) scan and cerebrospinal fluid analysis may be advised. Chest X-rays are taken if poisoning occurred through inhalation. Abdominal X-rays are instrumental in detecting ingested pesticides containing endrin or other organochlorines [9].

Blood samples are, via chromatography, play an important role in the detection and measurement of organochlorines in the body. As there is a toxic threshold, it is crucial to note that a positive result may simply indicate exposure, and not endrin poisoning [10]. The metabolism of endrin leads to the excretion of its metabolites in urine. The concentration of the latter may be measured, however this technique is preferentially employed in cases of chronic exposure.

Treatment

  • 335 Medical Education visàvis Medical Practice 346 Medical Negligence 361 Consent to and Refusal of Treatment 370[books.google.de]
  • Guest Guest Treatment of Endrin poisoning is with: a. Atropine b. Oximes c. Supportive measures d. All of the above Guest, Jul 29, 2009 #1 Guest Guest All i think.But oximes are specific.[aippg.net]
  • Statistics and Research Methods Stem Cell Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment[jamanetwork.com]
  • […] dermal absorption, high lipid storage, early and late seizures occur -Endosulfan ( thiodan, cyclodan, others) high acute oral toxicity, high dermal absorption, low lipid storage, strong sulfur odor - Heptachlor (Drinox), restriced; fire ant control; soil treatment[quizlet.com]

Prognosis

  • Prognosis If the patient survives the convulsions, the possibilities of full recovery are good.[bvsde.paho.org]
  • Where lindane is suspected as a toxin, serum concentrations can help to guide management and prognosis. A level of 0.02 to 0.20 mg/L is indicative of a toxic exposure with higher levels at greater risk for seizures.[calpoison.org]

Epidemiology

  • Div of Field Svcs, Epidemiology Program Office; Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.[cdc.gov]
  • Other sections review findings from experimental investigations of toxicity, case reports of accidental and suicidal poisoning, and epidemiological studies of occupationally exposed workers.[apps.who.int]
  • As a result, many countries allow their use exclusively in public health campaigns to combat insect vectors of diseases of epidemiological importance, for example, malaria and dengue. Other countries have prohibited or restricted their use.[bvsde.paho.org]
  • Epidemiology The historic legacy of organochlorine pesticides is both impressive and controversial.[calpoison.org]
  • The epidemiology of the Talagang outbreak suggested that a shipment of food (possibly sugar) was contaminated en route to the city 17. Some simple reported examples from throughout the world 18 show how vulnerable and at what riskwe are.[jpma.org.pk]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The major acute effect of the organochlorine agents is central nervous system stimulation. Several mechanisms seem to contribute to this effect.[calpoison.org]

Prevention

  • It is estimated that many others were poisoned whose symptoms were not so severe as to cause them to seek medical care or to enter hospital.The author describes the course of the outbreaks and the measures taken to ascertain their cause and prevent their[read.qxmd.com]
  • الصفحة 1 - Pesticide means any substance or mixture of substances intended for preventing, destroying or controlling any pest, including vectors of human or animal disease, unwanted species of plants or animals causing harm during or otherwise interfering[books.google.com]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • In cases of occupational exposure, alert public health authorities to assist in prevention of further exposures in a potentially unsafe work environment.[emedicine.medscape.com]

References

Article

  1. Kintz P, Baron L, Tracqui A, Peton P, Coudane H, Mangin P. A high endrin concentration in a fatal case. Forensic Sci Int. 1992;54(2):177-80.
  2. Kanthasamy AG, Kitazawa M, Kaul S, et al. Proteolytic activation of proapoptotic kinase PKCdelta is regulated by overexpression of Bcl-2: implications for oxidative stress and environmental factors in Parkinson's disease. Ann N Y Acad Sci. 2003;1010:683-686.
  3. van der Hoek W, Konradsen F. Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health. 2005;10(6):589-596.
  4. Wilson WW, Shapiro LP, Bradner JM, Caudle WM. Developmental exposure to the organochlorine insecticide endosulfan damages the nigrostriatal dopamine system in male offspring. Neurotoxicology. 2014;44:279-287.
  5. Bhalla M, Thami GP. Reversible neurotoxicity after an overdose of topical lindane in an infant. Pediatr Dermatol. 2004;21(5):597-599.
  6. U.S. National Library of Medicine. Endrin. Toxonet. https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+198. Accessed May 27, 2017.
  7. Joy RM. The effects of neurotoxicants on kindling and kindled seizures. Fundam Appl Toxicol. 1985;5(1):41-65.
  8. National Academy of Sciences. Drinking Water & Health Volume 1. https://www.nap.edu/read/1780/chapter/8#563. Published November 1977. Accessed May 27, 2017.
  9. Dally S, Garnier R, Bismuth C. Diagnosis of chlorinated hydrocarbon poisoning by x ray examination. Br J Ind Med. 1987;44(6):424-425.
  10. Centers for Disease Control and Prevention. The Fourth National Report on Human Exposure to Environmental Chemicals. Centers for Disease Control and Prevention. https://www.cdc.gov/exposurereport/. Published February 2009. Updated January 2017. Accessed May 27, 2017.

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Last updated: 2019-06-28 11:58