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]

  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]

• Malnutrition

  Repeated exposures and malnutrition also increase the risk of toxicity. In addition, nausea, vomiting, cyanosis or pallor, and hypotension can also be seen with toxic exposures. [calpoison.org]

• Nausea

  Pang Medicine Nephron 1992 A 24-year-old male who drank half a glass of beer that had been accidentally contaminated with about 1 ml of endosulfan developed nausea, vomiting and dizziness followed by loss of consciousness for 2 h, then developed facial [semanticscholar.org]

  After the hospitalization, he had somnolence, muscular fibrillation, irritation, nausea and vomi tting and arrhythmia. [jstage.jst.go.jp]

  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]

  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]

• Diarrhea

  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]

  Ingestion Nausea, vomiting, and diarrhea may occur following ingestion. Inhalation Reduced gas exchange, irritation, and chemical pneumonitis may occur. Skin Extensive contact results in dermal irritation. [microkat.gr]

  In the case of ingestion, gastrointestinal irritation (vomiting and diarrhea) are presented. [bvsde.paho.org]

• Choking

  The victim could choke to death on the vomitus. Never induce vomiting if the victim has swallowed a corrosive poison. Find out what poison the person has ingested. A corrosive poison is strong acid or alkali. [psep.cce.cornell.edu]

  Written order from 1st class Magistrate or coroner. 384 Most common mode of death in strangulation is Asphyxia. 385 The common mode of choking is Accidental. 386 Caffey syndrome is Battered baby syndrome. 387 In judicial hanging, fracture/dislocation [doctorshangout.com]

• 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]

  Parathion poisoning from contaminated barley.Lancet 1960;1: 538–542 Article Google Scholar Weeks DE. Endrin food poisoning. [link.springer.com]

• 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]

• Cyanosis

  In addition, nausea, vomiting, cyanosis or pallor, and hypotension can also be seen with toxic exposures. There are also reports of hematologic toxicity (pancytopenia and aplastic anemia) with repeated exposures to lindane. [calpoison.org]

• Dermatitis

  Laboratory animal exposure to endrin is associated with dermatitis and alopecia. [bvsde.paho.org]

• Miosis

  This case was different from most of the past cases in the following point s: 1) Delayed appearance of simptoms (22 hours) 2) No clonic and tonic spasm 3) The hastened precipitation of blood (14 sick days) 4) Miosis 5) Instability of patellar reflection [jstage.jst.go.jp]

• Suggestibility

  […] more likely than controls to have eaten bread in the 4 hours before becoming ill, and scrapings of residue from the floor of the truck that brought wheat flour from the mill to the general store where the baker purchased it were positive for parathion, suggesting [semanticscholar.org]

  الصفحة 36 - Enzyme studies with human and hen autopsy tissue suggest omethoate does not cause delayed neuropathy in man, Arch.Toxicol. ‏ [books.google.com]

  Experiments to investigate this phenomenon were carried out on dogs and suggested mechanisms of actions have been proposed. [rosap.ntl.bts.gov]

  Teaching Outline This gives a suggested curriculum using parts of 1 and 2. 4. Topic Structure This gives an overall topic structure for all content. [curriculum.toxicology.wikispaces.net]

• Convulsions

  Endrin was detected in the blood of 12 of 18 patients with a history of convulsions but was not found in the blood of four hospitalized control patients. [ncbi.nlm.nih.gov]

  Prognosis If the patient survives the convulsions, the possibilities of full recovery are good. [bvsde.paho.org]

• Seizure

  After the seizures in March, he had been diagnosed as epileptic and begun on long-term anticonvulsants. [cdc.gov]

  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]

  The most frequent of these is generalized tonic-clonic seizures. These may commence abruptly, with no prodromes, minutes to days after exposure. [symptoma.com]

  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]

• 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]

  Pang Medicine Nephron 1992 A 24-year-old male who drank half a glass of beer that had been accidentally contaminated with about 1 ml of endosulfan developed nausea, vomiting and dizziness followed by loss of consciousness for 2 h, then developed facial [semanticscholar.org]

  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]

  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]

• 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]

• Tremor

  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]

  Sensory disturbances, excitation with myoclonic jerking, convulsions, tremor, ataxia, agitation, nervousness, and amnesia may occur. Permanent damage may occur following acute exposure. [microkat.gr]

  Lindane, like other organochlorine pesticides, is excitatory to the brain and induces seizures, tremors and other stimulatory neurologic signs. [calpoison.org]

  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]

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.

335 Medical Education visàvis Medical Practice 346 Medical Negligence 361 Consent to and Refusal of Treatment 370 [books.google.de]

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]

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]

Avoid use of ointments, greases, powders, and other drugs in first aid treatment of burns. Recognize the signs of pesticide poisoning and know first aid treatment for it. Know the importance of a pesticide first aid kit and what it should contain. [psep.cce.cornell.edu]

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]

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]

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 and general management of poisonings by pesticides.Pediatr Clin North Am. 1970;17: 629–644 PubMed Google Scholar Fredricksson T. Percutaneous absorption of parathion and paraoxon IV. [link.springer.com]

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]

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

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]

Centers for Disease Control and Prevention. Acute convulsions associated with endrin poisoning--Pakistan. MMWR Morb Mortal Wkly Rep. 1984 Dec 14. 33(49):687-8, 693. [QxMD MEDLINE Link]. Centers for Disease Control and Prevention. [emedicine.medscape.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]

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

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.