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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.

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]
Hypoxemia
  • 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]
Tenesmus
  • 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]
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]
  • 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]
  • Seizures may begin without any prodromal signs or symptoms. If the patient is paralyzed after intubation, electroencephalographic monitoring is warranted.[emedicine.medscape.com]
Neglect
  • Sterilisation and Artificial Insemination 393 Nullity of Marriage Divorce and Legitimacy 400 Forensic Psychiatry 405 Forensic Toxicology 427 Intricacies of Forensic Toxicology 438 Duties of a Doctor in Cases of Suspected Poisoning 448 Starvation and Neglect[books.google.de]
  • Explore the possibility of child, elder, or vulnerable adult abuse or neglect.[emedicine.medscape.com]
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]
  • In addition, nonspecific neurologic symptoms such as nausea, vomiting, headaches, and dizziness can also be seen. Myoclonus, increased deep tendon reflexes and tremors are also reported following toxic exposures.[calpoison.org]
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]
  • 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]
Ataxia
  • 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]

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

  • 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]
  • 335 Medical Education visàvis Medical Practice 346 Medical Negligence 361 Consent to and Refusal of Treatment 370 Corrosive Poisons 454 Nonmetallic and Metallic Irritants 463 Irritants of Plant Origin 476 Somniferous Group 489 Alcohol and Alcoholism 495[books.google.de]
  • 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]
  • WikiTox is an open access curriculum project to improve the treatment of people who are poisoned. All content is freely accessible to anyone who visits the site, membership is not required.[curriculum.toxicology.wikispaces.net]

Prognosis

  • 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]
  • 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

  • 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]
  • A Checklist for Preventing Pesticide Accidents Everyone can improve their methods for safe handling of pesticides.[psep.cce.cornell.edu]

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:@[email protected]+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: 2018-06-22 07:47