title: Acute endosulfan poisoning with cerebral edema and cardiac failure.
abstract: BACKGROUND
  Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide with several deaths. Despite their widespread use in agriculture during the 1940s to 1960s and the well-known signs and symptoms of intoxication, the clinical picture in case of poisoning varies. We report two cases of acute intentional endosulfan intoxication with cerebral edema and cardiac failure.
  
  
  METHODS
  Both cases developed life-threatening signs like epileptic state, respiratory insufficiency and hemodynamic instability soon after ingestion. The survivor developed severe myocardial insufficiency and pulmonary edema documented by echocardiography and x-ray of the chest. The deceased patient developed severe cerebral edema and multiorgan failure ten days after ingestion of Thiodan 35. The peak serum concentration of endosulfan in the survivor was 0.12 mg/L approximately 23 hours after ingestion, whereas the peak blood concentration in the fatal case was 0.86 mg/L approximately 25 hours post-ingestion. Post-mortem endosulfan levels in different organs were determined.
  
  
  CONCLUSIONS
  Endosulfan is a highly toxic organochlorine insecticide that produces well-known neurological symptoms of tonic-clonic convulsions, headache, dizziness and ataxia but also can cause gastrointestinal symptoms and metabolic disturbances. Life-threatening cerebral edema and hemodynamic instability may occur. Treatment is symptomatic and supportive.
authors.affiliation: Department of Toxicology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. Florian.Eyer@t-online.de
authors.forename: Florian
authors.initials: F
authors.lastname: Eyer
authors.forename: Norbert
authors.initials: N
authors.lastname: Felgenhauer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jetzinger
authors.forename: Rudolf
authors.initials: R
authors.lastname: Pfab
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Zilker
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000188:drug therapy; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000503:physiopathology; D001463:Barbiturates / Q000627:therapeutic use; D001929:Brain Edema / Q000139:chemically induced*; D002303:Cardiac Output, Low / Q000139:chemically induced*; D004726:Endosulfan / Q000493:pharmacokinetics / Q000506:poisoning*; D017809:Fatal Outcome; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007306:Insecticides / Q000493:pharmacokinetics / Q000506:poisoning*; D008875:Middle Aged; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy; D014018:Tissue Distribution
chemical_list: D001463:Barbiturates; D007306:Insecticides; D004726:Endosulfan