title: High anion gap refractory metabolic acidosis as a critical presentation of endosulfan poisoning.
abstract: Organochloride insecticides are chlorinated cyclic hydrocarbons. One of such insecticides is endosulfan (6,7,8,9,10-10 hexachloro 1,5,5a,6,9,9a-hexahydro-6-methano-2,4,3-hexadithioxanthiep in 3-oxide) and it has been widely used in agriculture since 1960. The uncontrolled use of these compounds in developing countries has resulted in the deaths of animals and humans. Characteristic clinical signs following acute exposure are indicative of CNS disturbances or overstimulation. Mortality and morbidity rates are high and there is no specific antidote. We present an uncommon presentation of endosulfan poisoning in a 32-year-old male with high anion gap severe refractory metabolic acidosis. The patient was treated with continuous renal replacement therapy and was salvaged. Till date, there is no case report from India for endosulfan poisoning with severe metabolic acidosis and hypotension. Through this case report, we emphasize the role of continuous renal replacement therapy as a rescue therapy for endosulfan poisoning with severe refractory metabolic acidosis and hypotension, even though it is a non dialyzable poison.
authors.affiliation: Department of Nephrology and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Sharma
authors.forename: Anupama
authors.initials: A
authors.lastname: Kaul
authors.forename: Anurag
authors.initials: A
authors.lastname: Gupta
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Bhadauria
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.forename: Apoorva
authors.initials: A
authors.lastname: Jain
authors.forename: M
authors.initials: M
authors.lastname: Gurjar
authors.forename: Bhaskar P
authors.initials: BP
authors.lastname: Rao