title: Oral C-4 plastic explosive in humans - a case series.
abstract: 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.
authors.affiliation: South Asian Clinical Toxicology Research Collaboration Clinical Unit, Anuradhapura General Hospital, North Central Province, Sri Lanka.
authors.forename: James O J
authors.initials: JO
authors.lastname: Davies
authors.forename: Darren M
authors.initials: DM
authors.lastname: Roberts
authors.forename: Ariyasena
authors.initials: A
authors.lastname: Hittarage
authors.forename: Nick A
authors.initials: NA
authors.lastname: Buckley
mesh_terms: 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*
chemical_list: D010710:Phosphates; D014227:Triazines; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; C009160:cyclonite