Accidental oral poisoning caused by RDX (cyclonite): a report of 5 cases.
The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.
Küçükardali
Yaşar
Y
GATA Haydarpaşa Training Hospital, 81327 Usküdar, Istanbul, Turkey. ykuc@turk.net.
Acar
H Volkan
HV
Ozkan
Sezai
S
Nalbant
Selim
S
Yazgan
Yusuf
Y
Atasoyu
E Murat
EM
Keskin
Ozcan
O
Naz
Alişan
A
Akyatan
Nevzat
N
Gökben
Merih
M
Danaci
Mehmet
M
D000062:Accidents, Occupational; D000138:Acidosis / Q000139:chemically induced; D000328:Adult; D020324:Amnesia, Anterograde / Q000139:chemically induced; D000740:Anemia / Q000139:chemically induced; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D003128:Coma / Q000139:chemically induced; D003221:Confusion / Q000139:chemically induced; D003422:Critical Care / Q000379:methods; D004638:Emergency Treatment / Q000379:methods; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced; D005751:Gastric Lavage; D006801:Humans; D007964:Leukocytosis / Q000139:chemically induced; D008297:Male; D008887:Military Medicine / Q000379:methods; D008889:Military Personnel; D009325:Nausea / Q000139:chemically induced; D011041:Poisoning / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D012021:Reflex, Abnormal / Q000187:drug effects; D006435:Renal Dialysis; D014227:Triazines / Q000097:blood / Q000506:poisoning*; D014421:Turkey; D014839:Vomiting / Q000139:chemically induced
D014227:Triazines; C009160:cyclonite