Oral C-4 plastic explosive in humans - a case series.
BACKGROUND
C-4 is a plastic explosive widely used for demolition in both military and civilian settings. Severe toxicity following unintentional oral exposures or abuse have been reported in single case reports and small case series.


METHODS
Seventeen previously healthy male Army commandos admitted to a secondary referral hospital in Sri Lanka following oral C-4 poisoning.


METHODS
This data was collected as part of a prospective cohort study recruiting all patients admitted to general hospitals in Sri Lanka with a history of poisoning. History, clinical, and laboratory outcomes were recorded until discharge.


RESULTS
All 17 patients survived. The prominent clinical features were seizures, headache, nausea, and vomiting. Hypokalaemia and elevation of creatine kinase, lactate dehydrogenase, and phosphate were noted in all but two patients. Metabolic acidosis occurred in two patients following seizures and this resolved spontaneously.


CONCLUSIONS
Management recommendations include standard resuscitation, supportive care, and benzodiazepines for the control of seizures or agitation. Poisoning with C-4 is an unusual cause of seizures which should be considered in patients with access to this agent.
Davies
James O J
JO
South Asian Clinical Toxicology Research Collaboration Clinical Unit, Anuradhapura General Hospital, North Central Province, Sri Lanka.
Roberts
Darren M
DM
Hittarage
Ariyasena
A
Buckley
Nick A
NA
D000328:Adult; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008889:Military Personnel; D010710:Phosphates / Q000097:blood; D012640:Seizures / Q000097:blood / Q000139:chemically induced*; D013188:Sri Lanka; D014227:Triazines / Q000506:poisoning*
D010710:Phosphates; D014227:Triazines; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; C009160:cyclonite