AN OBSERVATIONAL STUDY OF 11 CASES OF CARTAP POISONING - A RARE POISONING

Authors

  • Rekha Das Department of Anesthesia and Critical Care, AHRCC and ICU Consultant, Shanti Memorial Hospital, Cuttack, Odisha, India
  • Sumita Mohanty Department of Anesthesia and Critical Care, AHRCC, Cuttack, Odisha, India
  • Sanjay Kumar Behera Department of Medicine, SCB Medical College, Cuttack, Odisha, India.
  • Ranjender Kumar Medikonda Intensive Care Unit, Shanti Memorial Hospital, Cuttack, Odisha, India.

DOI:

https://doi.org/10.22159/ajpcr.2017.v10i11.19069

Keywords:

Cartap hydrochloride poisoning, Intensive care unit, N-acetylcysteine

Abstract

 

 Objective: Cartap hydrochloride poisoning is an uncommon poisoning encountered in India. The aim of this study was to assess the characteristics, severity, management, and outcome of patients with Cartap poisoning, treated with N-acetylcysteine (NAC) in intensive care unit (ICU) of a tertiary referral hospital.

Methods: This is a retrospective study where 11 cases of Cartap poisoning admitted to hospital ICU between 2011 and 2016 were identified from the case records. The demographic data, mode of ingestion, time to treat, ingested dose and severity of poisoning, presenting features, duration of mechanical ventilation (MV), dose of NAC used, complications, and outcome were noted.

Results: Patients were scored as moderate or severe cases of poisoning. Severe cases consumed >10 g, underwent gastric lavage > 4 hrs, and took Cartap concomitantly with alcohol or in empty stomach. Duration of MV varied from 68-94 hrs in severe cases and 12-48 hrs in moderate cases. Average dose of NAC in severe case was 11.19 g and moderate case was 8.89 g. The most common presenting symptoms were vomiting, altered sensorium, and breathlessness. Severe cases had more complications, and the most common complication was hypotension followed by seizures. Survival was 100%.

Conclusion: 50% of Cartap poisoning cases had good survival outcome. Severity of poisoning depends on amount of Cartap ingested, time taken for gastric lavage, and concomitant administration of alcohol. Duration of MV and dose of NAC and complications encountered correlates with the severity of poisoning.

Downloads

Download data is not yet available.

Author Biography

Rekha Das, Department of Anesthesia and Critical Care, AHRCC and ICU Consultant, Shanti Memorial Hospital, Cuttack, Odisha, India

Anaesthesia and Critical care

References

Ray DE. Insecticides derived from plants and other organisms. Handbook of Insecticide Toxicology, Classes of Insecticide. Vol. 2. New York: Academic Press; 1991. p. 611-2.

Koyama K. Miscellaneous pesticides and fungicides. Jpn J Acute Med 1988;12:1457-61.

Liao JW, Pang VF, Jeng CR, Chang SK, Hwang JS, Wang SC. Susceptibility to cartap-induced lethal effect and diaphragmatic injury via ocular exposure in rabbits. Toxicology. 2003;5(192):139-48.

Liao JW, Kang JJ, Liu SH, Jeng CR, Cheng YW, Hu CM, et al. Effects of cartap on isolated mouse phrenic nerve diaphragm and its related mechanism. Toxicol Sci 2000;55(2):453-9.

International Programme of Chemical Safety. The WHO Recommended Classification of Pesticides by Hazard and Guidelines to Classification: 2009. Germany: World Health Organization; 2010.

International Programme of Chemical Safety. The WHO Recommended Classification of pesticides by Hazard and Guidelines to Classification 2000-2001. In: WHO, editors. WHO/PCA/0.1.5. Geneva: IOMC; 2002. p. 1-58.

Available from: http://www.gains.fas.usda.gov/maximum residue

limits for pesticide in food China. [Last accessed on 2017 Apr 08].

Persson H, Sjöberg G, Haines J, Pronczuk de Garbino J. Poisoning severity score: Grading of acute poisoning. J Toxicol Clin Toxicol 1998;36(3):205-13.

Boorugu Hk, chrispal A. cartap hydrochloride poisoning: A clinical experience. Indian J Crit Care Med 2012;16(1):58-9.

Gupta M, Handa D, Chaturvedi A, Singh R, Lehl SS. Cartap poisoning: An unusual poisoning in North India. Int J Sci Rep 2015;1(1):99-101.

Ahmed SM, Das B, Nadeem A, Samal RK. Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital. Indian J Anaesth 2014;58(1):11-7.

Raymond-Delpech V, Matsuda K, Sattelle BM, Rauh JJ, Sattelle DB. Ion channels: Molecular targets of neuroactive insecticides. Invert Neurosci 2005;5:119-33.

Kurisaki E, Kato N, Ishida T, Matsumoto A, Shinohara K, Hiraiwa K. Fatal human poisoning with Padan: A cartap-containing pesticide. Clin Toxicol (Phila) 2010;48(2):153-5.

Kuwahara H, Nakamura K, Morimura N, Shimizu M, Ishikawa J, Sugiyama MA, et al. Case of acute cartap poisoning. Kanto J Jpn Acute Med 2000;21:190-1.

Senthilkumaran S, Balamurgan N, Thirumalaikolundusubramanian P. Emerging epidemic of cartap self-poisoning in Southern India: A prospective observational study. J Gen Med 2007;19:54-5.

Sodalangunta MB, Sudulagunta SR, Khorram H, Sepehrar M. Cartap hydrochloride causing respiratory failure and seizures. Int J Med Pharm Case Rep 2015;5(2):1-4.

Kumar AS, Amalnath D, Dutta TK. Cartap poisoning: A rare case report. Indian J Crit Care Med 2011;15(4):233-5.

Cao BJ, Chen ZK, Chi ZQ. Antidotal effects of sulfhydryl compounds on acute poisonings by sodium ammonium dimethyl-2-(propane-1,3-dithiosulfate) monohydrate, nereistoxin and cartap. Zhongguo Yao Li Xue Bao 1990;11(2):180-4.

Harsha T, Abhilesh KP, Hansdak SG. Cartap hydrochloride poisoning: A clnical experience with N-acetyl cysteine therapy. J Med Sci Res 2013;4(1):30-1.

Kalyaniwala K, Abhilash KP, Victor PJ. Cartap hydrochloride poisoning. J Assoc Physicians India 2016;64(8):91-2.

Bunai Y, Akaza K, Tsujinaka M, Nakamura I, Nagai A, Takekoshi Y, et al. An autopsy case of fatal cartap poisoning. Res Pract Forensic Med 2001;44:111-4.

Kiyota K, Honma M, Shigeta M, Miyake Y, Sakamoto T, Aruga T, et al. Cartap intoxication-pharmacokinetic analysis. Jpn J Toxicol 1994;7:263-70.

Ajit S, Rajesh V, Sonal S, Shastri B, Sarasavu K. Cyclophosphamide induced fatal cytopenia: A case of paraquat poisoning. Int J Pharm Pharm Sci 2016;8(10):296-7.

Khan P, Charry M, Kumar M, Nousheen B. A study on treatment pattern and outcomes of poisoning cases in a tertiary care and government district hospital. Int J Pharm Pharm Sci 2017;9(4):193-7.

Yashwant DS, Mohan CP, Adavirao V. Grey water farming of ladies finger and cluster beans-induces dietary toxicity?. Int J Curr Pharma ceutical Research 2017; 9(4): 201.

Published

01-11-2017

How to Cite

Das, R., S. Mohanty, S. K. Behera, and R. K. Medikonda. “AN OBSERVATIONAL STUDY OF 11 CASES OF CARTAP POISONING - A RARE POISONING”. Asian Journal of Pharmaceutical and Clinical Research, vol. 10, no. 11, Nov. 2017, pp. 366-9, doi:10.22159/ajpcr.2017.v10i11.19069.

Issue

Section

Original Article(s)

Most read articles by the same author(s)