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Endosulfan, an organochlorine (OC) insecticide, is a widely used agricultural pesticide, despite its life threatening toxic effects. In this review, the pharmacokinetics of endosulfan, mechanism of endosulfan toxicity, clinical presentations and management, histopathological findings, and toxicological analysis are described, in addition to its environmental toxicity. The toxic effects of endosulfan can affect many organs and systems presenting in a wide array of signs and symptoms. Although termed a restricted OC-classed pesticide, it continues to be used, especially in the developing world, owing to its beneficial effects on agriculture. Several cases of endosulfan poisoning have been reported from different regions of the world. Whether accidental or intentional, endosulfan ingestion proves to be fatal unless immediate, aggressive treatment is initiated. Management is mainly supportive as no antidote exists for endosulfan poisoning as yet. The use of endosulfan needs to be strictly regulated and eventually banned worldwide altogether to lower the current morbidity and mortality resulting from this pesticide. Additionally, monitoring biological samples, using non-invasive techniques such as breast milk sampling, can provide an effective method of observing the elimination of this environmentally persistent organic pollutant from the general population. [ABSTRACT FROM AUTHOR]

We describe the case of a 12 year old boy who presented with acute endosulfan poisoning. On enquiry, the parents gave a history of suicidal consumption of endosulfan. On examination the patient was in status epilepticus, and his general condition was poor. After initial clinical and laboratory assessment the patient was treated with routine management of acute poisoning in the form of gastric lavage where the gastric contents were aspirated initially and the contents were collected for chemical analysis. The lavage was performed with activated charcoal. Since the seizures were non responsive to conventional first line anticonvulsant drugs for 30 minutes, we characterized the case as refractory status epilepticus. In view of the failure of above medication to control the seizures, further management for refractory seizures was initiated, the patient was intubated and put on mechanical ventilation with a loading dose of thiopentone sodium (5 mg/kg). The seizures ceased in 30 minutes. The rate of the infusion was gradually reduced and stopped as flickering movements subsided. After the 5th day the condition of the patient improved and he regained consciousness and was slowly weaned off the ventilator. The patient was discharged on the 10th day from admission in an ambulatory state with no seizures and no neurological deficits. Conclusion - We suggest the use of other antiepileptic drugs, such as thiopentone sodium, to treat refractory status epilepticus. [ABSTRACT FROM AUTHOR]

Introduction: a number of families in a rural area of Jabalpur District (Madhya Pradesh), India, were affected by repeated episodes of convulsive illness over a period of three weeks. The aim of this investigation was to determine the cause of the illness. METHODS: the investigation included a house-to-house survey, interviews of affected families, discussions with treating physicians, and examination of hospital records. Endosulfan poisoning was suspected as many villagers were using empty pesticide containers for food storage. To confirm this, our team collected blood and food samples, which were transported to the laboratory and analyzed with GC-ECD. RESULTS: thirty-six persons of all age groups had illness of varying severity over a period of three weeks. In the first week, due to superstitions and lack of treatment, three children died. In the second week, symptomatic treatment of affected persons in a district hospital led to recovery but recurrence of convulsive episodes occurred after the return home. In the third week, 10 people were again hospitalized in a teaching hospital. Investigations carried out in this hospital ruled out infective etiology but no facilities were available for chemical analysis. All persons responded to symptomatic treatment. The blood and food samples analyzed by our team showed presence of endosulfan, which was confirmed by GCMS. One of the food items (Laddu) prepared from wheat flour was found to contain 676 ppm of α-endosulfan. CONCLUSIONS: Contamination of wheat grains or flour with endosulfan and its consumption over a period of time was the most likely cause of repeated episodes of convulsions, but the exact reason for this contamination could not be determined. This report highlights the unsafe disposal of pesticide containers by illiterate farm workers, superstitions leading to delay in treatment, and susceptibility of children to endosulfan. [ABSTRACT FROM AUTHOR]

Background: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production., Methods: Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006., Results: The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20-29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively., Conclusion: APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.

Objective: Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity., Case Report: A 33-years-old healthy woman with  a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department. Cardiac arrest ensued after one hour of admission. Cardiopulmonary resuscitation was initiated in accordance with advanced cardiac life support (ACLS) algorithm for asystole. During resuscitation, 2 mL/kg bolus of 20% intravenous lipid emulsion (ILE) was administered for three times at five-minute intervals in addition to ACLS guidance. Spontaneous circulation returned after twenty minutes of resuscitation. No additional antidotal or vasopressor therapies were required during the hospital course of the patient. To our knowledge, this is the first reported case with responded use of ILE treatment for endosulfan toxicity., Conclusion: This case report indicates that ILE treatment should be considered for life-threatening endosulfan intoxications.

Endosulfan is a highly toxic pesticide that causes hyperstimulation of the central nervous system by antagonizing gamma aminobutyric acid-mediated inhibition. Seizure is the most important manifestation of endosulfan poisoning, frequently progressing to status epilepticus and refractory status epilepticus. Here, we report a recent case of a 64-year-old man with endosulfan-induced super-refractory status epilepticus, which persisted for a remarkably longer period than has been described in previous reports. The patient arrived at the emergency room with continuous generalized tonic-clonic seizures. Electroencephalogram-recorded seizures that persisted even after intravenous administration of lorazepam and antiepileptic drugs. Intravenous anesthetic agents were administered for 9 days to confront the persistently recurring seizures. Immediately after this treatment period, the seizures subsided, and the patient showed marked neurological improvement. After 2 months however, he died of multiple systemic complications. This case report elucidates the importance of aggressive evaluation and management including continuous EEG monitoring in cases of endosulfan-related status epilepticus.

Endosulfan is an organochlorine pesticide that is used extensively across the world to kill insects. Incidence of acute and chronic toxicity with endosulfan poisoning has been reported, and nearly 80 countries have banned its use. However, it is still being used in many low-income/middle-income countries. One of the most severe tragedies because of endosulfan poisoning has taken place in the Indian state of Kerala due to persistent aerial spraying of endosulfan. Even though there are reports of skeletal and other congenital abnormalities in humans and experimental animals following exposure to endosulfan, very few have been documented. We report two cases of congenital scoliosis in siblings living in a community affected by high levels of endosulfan in the environment. High index of suspicion is essential during the screening of school children exposed to endosulfan. Congenital scoliosis is a progressive deformity that leads to severe disability, unless detected and corrected at an early stage., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: This study investigated the predictive factors for progression from seizure-related endosulfan poisoning to status epilepticus (SE) and refractory SE (RSE). This study also investigated delayed neurologic sequelae in seizure-related endosulfan poisoning., Methods: This retrospective, observational case series consisted of 73 patients who developed at least one seizure after endosulfan ingestion., Results: The progression rates from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE were 78.1% and 54.4%, respectively. The SE and RSE fatality rates were 19.2% and 41.9%, respectively. No patients reported the development of delayed neurological sequelae at least six months after discharge. Glasgow coma scale (GCS) score were identified as an independent factor for progression from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE. Lorazepam administration was independently associated with preventing progression from SE-related endosulfan poisoning to RSE., Conclusion: Seizure-related endosulfan poisoning had higher progression rates to SE and RSE and higher fatality rates than other drug-induced seizures. However, delayed neurologic sequelae after discharge were not demonstrated. Due to the high progression rates from seizure-related endosulfan poisoning to SE and RSE and the absence of an established treatment for SE-related endosulfan poisoning, physicians should aggressively treat patients who experience a seizure after endosulfan poisoning and who present with decreased GCS score. Lorazepam should be considered a first-line anti-epileptic drug for controlling seizures in patients with endosulfan poisoning., (Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Endosulfan, a highly toxic insecticide and acaricide, was globally banned under the Stockholm Convention in May 2011 because of its threats to human health and the environment. Despite the ban on its use, endosulfan is still present in the environment, causing poisoning events in domestic animals and wildlife. Toxicologic analysis of poisoned animals conducted by the Istituto Zooprofilattico Sperimentale del Mezzogiorno revealed that in the past 3 y, this pesticide has not disappeared in the regions of interest. More than 650 samples (baits and animal organs) collected from 2013 to 2015 were analyzed through solid-phase extraction followed by gas chromatography-electron capture detection. This methodology allowed us to identify 45 positive samples from the Calabria region of southern Italy (10.2 % of the total samples). Most were samples of gastric content (alpha-endosulfan range: 1.27-3,800 mg/kg) and baits (alpha-endosulfan range: 92-1,497 mg/kg). Lower concentrations of pesticide were found in samples of stomach (alpha-endosulfan: 6.7-118 mg/kg) and liver (alpha-endosulfan: 0.38-14.2 mg/kg).

Acute Endosulfan poisoning is associated with a high mortality rate in humans, and can exceed 30% [Moon JM, Chun BJ. Acute endosulfan poisoning: a retrospective study. Hum Exp Toxicol 2009;28:309-16]. Prophylactic anticonvulsant therapy for symptomatic patients and aggressive treatment for seizures may limit morbidity, but, no effective antidote is available [Moses V, Peter JV. Acute intentional toxicity: endosulfan and other organochlorines. Clin Toxicol (Phila) 2010;48:539-44]. However, endosulfan poisoning is often completely reversible with the appropriate management [Karatas AD, Aygun D, Baydin A. Characteristics of endosulfan poisoning: a study of 23 cases. Singapore Med J 2006;47:1030-2]. Intravenous lipid emulsion (ILE) may be a useful in treatment of lipophilic medication overdoses as an adjunct to antidotal therapy [Rothschild L, Berns S, Oswald S, et al. Intravenous lipid emulsion in clinical toxicology. Scand J Trauma Resusc Emerg Med 2010;18:51]. We believe that this is its first reported use in endosulfan toxicity.

Context: We investigated the effects of endosulfan intoxication on pituitary functions in three patients., Methods: This is an observational case series including three patients with endosulfan intoxication. Patients were evaluated 3 months after the acute event., Results: Based on the baseline hormonal values and dynamic endocrine tests, one patient had hypothalamo-pituitary-adrenal axis impairment and was diagnosed as ACTH deficiency (peak cortisol level was found 13.12 μg/dl after low dose ACTH stimulation test), and another one had GH-IGF-I axis impairment and was diagnosed as GH deficiency (peak GH level was found 1.06 μg/L after glucagon stimulation test)., Conclusions: Endosulfan intoxication might cause pituitary hormone deficiencies after the acute phase. Therefore, patients with endosulfan toxicity should be followed for possible pituitary gland dysfunction.

Objectives: (1) To confirm the presence of Pesticide (Endosulfan) residues in the bone marrow (BM) of children with acute hematological malignancies and compare them with controls. (2) To ascertain if children with Endosulfan in their marrow reside in areas sprayed with Endosulfan., Study Design: Case control study, Setting: Pediatric oncology unit of a medical college teaching hospital in Dakshina Kannada district of Karnataka., Subjects: 26 patients with proven hematological malignancy and 26 age matched controls suffering from benign hematological disease., Methods: Endosulfan residues in the BM were estimated by gas chromatography mass spectrometry (Minimum detection limit 10ng/mL). The subjects geographical area of location (residence) was determined to see whether they belong to sprayed area or not. The Chi-square test was applied to see an association between exposure status and hematological malignancy., Results: A total of 52 children were enrolled of which 26 were study cases and 26 were controls. Of the study and control groups, 84.7% ;and 73.1%, respectively were from exposed areas. The major (88.4%) illness in the study group was ALL, while ITP (50%) occurred most frequently in the control group. Six out of 26 study cases tested positive for endosulfan in the BM, against 1 out of 26 controls (P = 0.042). The Odds ratio was 7.5. All children who had endosulfan in the bone marrow originated from areas, where endosulfan is still being used., Conclusions: Children with hematological malignancy had raised levels of endosulfan in the bone marrow compared to those without. All the children with raised bone marrow Endosulfan levels were found to be from areas exposed to the pesticide.

In Cukurova region, pesticide poisonings still remain an unfortunate cause of death, which led to the present study. The autopsy records of Adana Branch of the Council of Forensic Medicine, between 2006 and 2008, were evaluated retrospectively. Deaths that were attributed to pesticide poisoning were included in the scope of the study to identify the type of pesticide, and etiology of intoxication. The frequency and distribution of intoxications were also analyzed in terms of sex and age. In the studied period, a total of 4199 autopsies were referred to the forensic toxicology laboratory for pesticide analysis. Seventy-two cases were positive for pesticide analysis. Of these, 42 (58.33%) were male and 30 (41.67%) were female, with a mean age of 38.8 ± 20.6 years. Among the inspected pesticides, endosulfan was found to be the most common with 47.2% of prevalence, followed by dichlorvos. This report showed that certain pesticides, endosulfan in particular, remains as common cause of poisonings in Cukurova region.

Introduction: Organochlorine pesticides continue to be used in several developing countries despite concerns regarding their toxicity profile. Endosulfan is an organochlorine recognized as an important agent of acute toxicity., Methods: In this retrospective study, the clinical features, course, and outcomes among patients with acute endosulfan poisoning requiring admission to the hospital during an 8-year period (1999-2007) were reviewed., Results: Among 34 patients hospitalized during this study period for alleged organochlorine poisoning, 16 patients with endosulfan poisoning were identified. The majority (75%) received initial treatment at a primary or secondary center. Neurological toxicity predominated, particularly low sensorium (81%) and generalized seizures (75%), including status epilepticus (33%). Other features observed included hepatic transaminase elevation, azotemia, metabolic acidosis, and leukocytosis. Mechanical ventilation was required in 69% and vasoactive agents in 19%. In-hospital mortality was 19%. There were no gross neurological sequelae at discharge. In three other patients who presented with organochlorine poisoning, the compounds ingested were lindane, endrin, and dicofol (n = 1 each). The course and outcomes in these patients were unremarkable and all three patients survived., Conclusions: Endosulfan is capable of high lethality and significant morbidity. The commonest manifestations are neurological although other organ dysfunction also occurs. In the absence of effective antidotes, restriction of its availability, along with prompt treatment of toxicity, including preemptive anticonvulsant therapy are suggested.

Introduction: Endosulfan, an organochlorine insecticide widely used in agriculture, is rapidly absorbed following ingestion, inhalation, or skin exposure. Poisonings rarely result in morbidity and mortality. Symptoms occur rapidly following exposure with CNS toxicity. Endosulfan has been banned in many countries; however, it is still used in the United States., Case Report: A 2.5-year-old ingested an unknown amount of endosulfan from a 20-ounce soft drink bottle. He immediately developed generalized tonic-clonic seizure activity and became unresponsive. He was transferred to the local hospital and to a tertiary children's hospital where the seizures were refractory to treatment despite treatment with multiple anticonvulsants. He became hypotensive requiring vasopressors. On day 3, an MRI showed cerebral edema, and a nuclear medicine flow scan failed to show blood flow to the brain and he was pronounced dead., Discussion: This is the first published pediatric death in the United States because of endosulfan. Central nervous system stimulation is frequently the presenting symptom with or without other organ dysfunction. Status epilepticus causes the highest morbidity and mortality, therefore prompt administration of anticonvulsant drugs is important although not always effective. The child is our case demonstrated the most severe features of endosulfan exposure., Conclusion: In summary, prevention of a potentially toxic exposure is critical. The presence of this substance in a soft drink bottle contributed to the toxic exposure in this child, thus emphasizing the need for poison prevention education. The severe toxicity to those exposed raises the question of the need of this compound on the U.S. market.

Forensic toxicological analyses have traditionally focused on the use of blood, body fluids, and certain organs in examinations of deaths due to intoxication. However, in some situations, putrefaction and contamination make proper sampling from tissues impossible, such as in exhumation cases. In these cases, bone marrow might be useful as an alternative specimen since it is a potential depot for drugs. This study aims to determine pesticides in postmortem and putrefied bone marrow of pesticide treated rabbits, so as to reveal the diagnostic value of toxicological analysis of bone marrow in exhumation cases. Out of thirteen rabbits, a 110 mg/kg dose of endosulfan was orally given to six through a gavage tool, and a 2500 mg/kg dose of diazinon was given to six using the same method. One rabbit was not treated with anything and served as a control sample. Venous blood, liver, lung, kidney, brain, and bone marrow samples were collected just after spontaneous death or cervical dislocation. After this, the rabbits were buried in soil. All of them were exhumed 1 month later, and putrefied viscera and bone marrow were sampled. Blood and tissue samples underwent solvent extraction and solid phase extraction, and then the samples were analyzed by GC-MS. Mean residue levels of diazinon in early postmortem samples were 85 mg/kg, 71 mg/kg, 23 mg/kg, 21 mg/kg, 19 mg/kg, and 0.4 mg/l in the liver, bone marrow, kidney, lung, brain, and blood, respectively. Mean residue levels of diazinon in the putrefied body were 3327 mg/kg in putrefied viscera and 1783 mg/kg in the bone marrow. Mean residue levels of endosulfan isomers and metabolites in early postmortem samples (blood, liver, lung, kidney, brain, and bone marrow) were 0.46 mg/kg (endosulfan sulfate), 0.32 mg/kg (alpha and beta isomers of endosulfan), and 0.14 mg/kg (endosulfan ether) while the same levels were 0.26 mg/kg (endosulfan sulfate), 0.24 mg/kg (alpha and beta isomers of endosulfan), and 0.1 mg/kg (endosulfan ether) in putrefied samples (putrefied bone marrow and putrefied viscera). Based on these experimental results, it can be concluded that cause of death can be determined as acute pesticide poisoning by toxicological analysis of samples from bone marrow and putrefied viscera in exhumation cases.

Endosulfan is a widely used insecticide that is associated with a high fatality rate in humans when ingested accidentally or with the aim of suicide. However, the literature concerning human endosulfan exposure is limited to case reports. Thus, we sought to 1) describe the clinical features of patients with acute endosulfan poisoning and 2) identify independent factors to predict patients' outcome. Fifty-two patients who presented with acute endosulfan poisoning between January 2001 and January 2007 were enrolled in this retrospective study. Sixteen (30.7%) of the 52 patients died, and 48 patients experienced seizures. Endosulfan poisoning caused the hypotension and the abnormalities on electrocardiogram at presentation. Over half of the patients developed complications, such as rhabdomyolysis, hepatic toxicity, and hypotension. These complications resolved without sequelae in the survival group. Refractory status epilepticus was the most common cause of death in this series (75.0%). Amount ingested being greater than 35 g of endosulfan was the most found to be an independent variable that predicted patient mortality. Patients with this risk factor must be treated aggressively during the early stage of endosulfan poisoning.

This paper describes very rare chemical poisoning and characteristics of patients with acute endosulfan mass poisoning in a rural area of Turkey and our experiences of these patients. We included 41 patients who were treated in our hospital with the diagnosis of endosulfan poisoning. After the first vital intervention they were examined in terms of age, sex, symptoms and physical examination findings, laboratory results, treatment and outcome. Forty-one patients were admitted to the emergency department (ED) after triage. Nineteen (46.3%) of the patients were female, 22 (53.7%) were male. The mean age was 27.9+/-16.0 years (1-67 years). The mean time to the ED was 4.1+/-0.9 h (3-6.5 h). The most common symptoms were anxiety (97.6%), nausea (56.1%) and vomiting (48.8%). Tests of the blood samples obtained at the ED revealed leucocytosis (11 070.6+/-4302.5/microl), increased blood glucose, LDH, CK and CK-MB levels. Toxicological analysis of blood and urine samples revealed endosulfan as the causative agent. Especially in the rural areas, cases with acute repetitive seizures should suggest endosulfan intoxication when the aetiology is uncertain even in the absence of any signs of intoxication. Health care professionals should understand the hazards associated with the pesticide use as well as diagnosis and treatment of these types of poisonings.

Endosulfan is an organochloride insecticide, widely used in insect control. It is responsible for many severe intoxication and several deaths. We present a case series of endosulfan poisoning, admitted to our emergency department with different clinical courses. Two patients presented with status epilepticus and were successfully treated with thiopental sodium to control seizures. One patient required also hemodialysis. All patients were discharged following a complete recovery of their health. Endosulfan is a highly toxic insecticide that produces tonic-clonic convulsions, headache, dizziness and ataxia. It can cause also life threatening metabolic disturbances. Treatment is symptomatic and supportive (Tab. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Endosulfan is an organochlorine pesticide. It is banned in the USA and Europe, but use is unrestricted for insect control. Endosulfan causes many intentional and unintentional toxicities in developing countries and in Turkey. Acute exposure to endosulfan has rarely been reported in deaths due to ingestion. Here, a fatality of 61-year-old woman of a family who was poisoned due to ingestion of endosulfan has been reported. Based on autopsy findings, patient history and toxicological results, the cause of death was determined to be acute intoxication of endosulfan and the manner, unintentional toxicities. Endosulfan has histopathological toxic effects on many organs and this toxic effect occurs within a short period after ingestion. To prevent endosulfan poisoning, the usage of it must be restricted and even prohibited. To prevent death and to accelerate improvement, the organs that have more apparent histopathological injury should be considered and early and intensive supportive treatment be initiated.

We describe a 26-year-old female patient, who had attempted suicide with Endosulfan, and who presented to the Emergency Department with status epilepticus. She subsequently developed hypotension refractory to inotropes, intravascular hemolysis, disseminated intravascular coagulation (DIC), metabolic acidosis and, finally, cardiac arrest and death. Endosulfan is a chlorinated insecticide that causes central nervous system hyperstimulation. It is absorbed from the gastrointestinal tract, skin, and respiratory tract, and leads to nausea, vomiting, paraesthesia, giddiness, convulsion, coma, respiratory failure, and congestive cardiac failure. Hepatic, renal and myocardial toxicity, agranulocytosis, aplastic anemia, cerebral edema, DIC, thrombocytopenia, and skin reaction also have been reported. Management includes decontamination of skin and gastrointestinal tract, supportive care including treatment of status epilepticus, dysrhythmias, and mechanical ventilation. Mortality and morbidity rates are very high and there is no specific antidote. Atropine and catecholamines should be avoided.

Background: The pesticides monocrotophos, methamidophos, and endosulfan were a very common cause of severe poisoning in Sri Lanka during the 1980s and early 1990s, before they were banned in 1995 and 1998. Now, the most commonly used insecticides are the less toxic World Health Organization Class II organophosphorus pesticides and carbamates. These bans were followed by a large reduction in both fatal poisonings and suicide in Sri Lanka., Objective: We aimed to see if these bans adversely affected agricultural production or costs., Methods: We used data from the World Resources Institute to compare the yields of the main crop groups in Sri Lanka with those from surrounding South Asian countries for 1980-2005. We also examined data from the Sri Lankan Department of Census and Statistics to examine the yields of 13 specific vegetable crops and rice for 1990-2003, along with the costs of rice production., Results: We found no drop in productivity in the years after the main bans were instituted (1995, 1998). We observed substantial annual fluctuation in estimated yields in all data sources, but these did not coincide with the bans and were no larger than the fluctuations in other countries. Also, there was no sudden change in costs of rice production coinciding with bans., Conclusions: Countries aiming to apply restrictions to reduce deaths from pesticide poisoning should evaluate agricultural needs and develop a plan that encourages substitution of less toxic pesticides. If farmers have an affordable alternative for pest control for each crop, there is no obvious adverse effect on agricultural output.

Background: Endosulfan is widely used in insect control and is absorbed by both humans and animals through the intestinal tract, the lungs, and the skin. Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide, with several deaths. A 9-year analysis by one of Turkey's poison control centers reported that pesticide intoxications accounted for 8.8% of 25,572 poisoning calls, with 80.3% of them relating to insecticides and 19.7% concerning rodenticides., Case Reports: We present two cases of unintentional exposure to endosulfan, one of which presented with neurological manifestations, liver toxicity, and required mechanical ventilation and emergent hemodialysis; the other had only neurological manifestations and liver toxicity., Conclusion: In cases of endosulfan poisoning, physicians must be aware of neurological manifestations, seizures, and severe metabolic acidosis. If severe metabolic acidosis is present, we suggest that hemodialysis may be an important intervention and should be performed early.

Objective: Warangal district in Andhra Pradesh, southern India, records >1000 pesticide poisoning cases each year and hundreds of deaths. We aimed to describe their frequency and distribution, and to assess quality of management and subsequent outcomes from pesticide poisoning in one large hospital in the district., Methods: We reviewed data on all patients admitted with pesticide poisoning to a district government hospital for the years 1997 to 2002. For 2002, details of the particular pesticide ingested and management were abstracted from the medical files., Findings: During these 6 years, 8040 patients were admitted to the hospital with pesticide poisoning. The overall case fatality ratio was 22.6%. More detailed data from 2002 revealed that two-thirds of the patients were <30 years old, 57% were male and 96% had intentionally poisoned themselves. Two compounds, monocrotophos and endosulfan, accounted for the majority of deaths with known pesticides in 2002. Low fixed-dose regimens were used in the majority of cases for the most commonly used antidotes (atropine and pralidoxime). Inappropriate antidotes were also used in some patients., Conclusions: It is likely that these findings reflect the situation in many rural hospitals of the Asia Pacific region. Even without an increase in resources, there appear to be significant opportunities for reducing mortality by better medical management and further restrictions on the most toxic pesticides.

This report describes the characteristics of patients with acute pesticide poisoning in a rural area of Sri Lanka and, for intentional self-poisoning cases, explores the relative importance of the different determinants. Data were collected for 239 acute pesticide-poisoning cases, which were admitted to two rural hospitals in Sri Lanka. Sociodemographic characteristics, negative life events and agricultural practices of the intentional self-poisoning cases were compared with a control group. Most cases occurred among young adults and the large majority (84%) was because of intentional self-poisoning. Case fatality was 18% with extremely high case fatality for poisoning with the insecticide endosulfan and the herbicide paraquat. Cases were generally younger than controls, of lower educational status and were more often unemployed. No agricultural risk factors were found but a family history of pesticide poisoning and having ended an emotional relationship in the past year was clearly associated with intentional self-poisoning. The presence of mental disorders could only be assessed for a subsample of the cases and controls and this showed that alcohol dependence was a risk factor. This study shows that acute pesticide poisoning in Sri Lanka is determined by a combination of sociodemographic and psychological factors. Suggestions are given for interventions that could control the morbidity and mortality due to acute pesticide poisoning in developing countries.

We describe a case of refractory status epilepticus presenting to a rural general hospital in Sri Lanka. This patient's condition was precipitated by intentional self-poisoning with the organochlorine insecticide endosulfan. Although rarely seen in developed countries, pesticide poisoning particularly with endosulfan is an important cause of difficult-to-manage seizures in Asian countries. In this case report, we discuss the management of status epilepticus and refractory status epilepticus. Further, we specifically discuss the clinical pharmacology and toxicology of endosulfan.

Information in the open literature about the fate and effects of pesticides in small streams from agricultural areas of Argentina is very rare. The objective of the present work was to study the pesticide contamination and potential biological effects in basins that have undergone intense agricultural activity, mainly related to the cultivation of soybeans. Three streams (Maguire, Helves, and Horqueta) with a low-flow discharge (0.1 and 0.2 m3/s) in March close to the city of Arrecifes were studied during the period of maximum insecticide application, between February and April 2001. Various sampling devices were installed to trap suspended particles, runoff, and floodwater plus sediment throughout the study period. The suspended-particle samples were analyzed for the insecticides endosulfan (END), chlorpyrifos, and cypermethrin. Water chemistry and the macroinvertebrate communities were assessed on four occasions and the organismic drift was measured continuously. Following a 184-mm rainfall on March 1, 2001, beta-endosulfan concentrations up to 318 and 43 microg/kg were measured from suspended-particle samples from Horqueta and Helves, respectively. No END contamination was detected in Maguire. Chlorpyrifos and cypermethrin were not detected in any of the streams. A significant decrease in the average macroinvertebrate species density was observed in Horqueta (from 12.8 +/- 0.5 to 9 +/- 0.7 species; ANOVA, p < 0.05) and Helves (from 10.8 +/- 1.7 to 3.3 +/- 1.3 species; p < 0.001) following the same rainfall event at the beginning of March, while the species density in Maguire remained constant at 7.9 +/- 0.3 species. The runoff primarily reduced species abundances of Odonata and Ephemeroptera significantly (p < 0.01) in Horqueta and Helves but not in Maguire. A greater drift of Smicridae (Trichoptera) and Ephemeroptera occurred in Helves and Horqueta during this runoff event, while no changes in the macroinvertebrate drift were detectable in Maguire. This study highlights the potential pesticide effects on macroinvertebrate communities in Argentinian rural streams. It is suggested that a small wetland area formed by Maguire between the agriculturally used catchment and the sampling site contributes to the absence of contamination and effects at this site.

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., Case Reports: 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., Conclusion: 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.

There is experimental evidence of adverse effects of endosulfan on the male reproductive system, but there are no human data. Therefore, we undertook a study to examine the relationship between environmental endosulfan exposure and reproductive development in male children and adolescents. The study population was composed of 117 male schoolchildren (10-19 years of age) of a village situated at the foothills of cashew plantations, where endosulfan had been aerially sprayed for more than 20 years, and 90 comparable controls with no such exposure history. The study parameters included recording of clinical history, physical examination, sexual maturity rating (SMR) according to Tanner stages, and estimation of serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone, and endosulfan residues (70 study and 47 control subjects). Mean +/- SE serum endosulfan levels in the study group (7.47 +/- 1.19 ppb) were significantly higher (p < 0.001) than in controls (1.37 +/- 0.40 ppb). Multiple regression analysis showed that SMR scoring for development of pubic hair, testes, penis, and serum testosterone level was positively related to age and negatively related to aerial exposure to endosulfan (AEE; p < 0.01). Serum LH levels were significantly positively related to AEE after controlling for age (p < 0.01). The prevalence of congenital abnormalities related to testicular descent (congenital hydrocele, undescended testis, and congenital inguinal hernia) among study and controls subjects was 5.1% and 1.1%, respectively, but the differences were statistically nonsignificant. Our study results suggest that endosulfan exposure in male children may delay sexual maturity and interfere with sex hormone synthesis. Our study is limited by small sample size and nonparticipation.

Unrestricted use of endosulfan, a cyclic chlorinated hydrocarbon insecticide, results in many intentional and unintentional toxicities in Turkey. Due to its chemical stability in the environment, toxicity may be seen even if exposure happens 6-mo after the endosulfan has been sprayed. We discuss a case of 2 patients with unintentional exposure to endosulfan after eating contaminated foods, one of which presented with neurological manifestations and required mechanical ventilation, the other having only mild symptoms. Because of the toxicity to humans and threats for nature, use of endosulfan should be restricted or banned.

Endosulfan poisoning was observed in cattle where the owner applied the insecticide topically as ectoparasitic control. Two of 11 cattle died in 2 d with rapid and difficult breathing, foamy exudates in the mouth, tremors, exophthalmos and coma. At necropsy, hemorrhages were on the serosal membranes of the visceral organs and lungs, and there was severe edema and emphysema in the lungs. The levels of endosulfan in the liver, kidney, lungs and muscle were 13.1, 4.0, 1.6 and 0.8 ppm, respectively.

To commit suicide, three young adults swallowed a relatively small amount of a widely used insecticide containing endosulfan. They developed recurrent epileptic seizures. After hospitalization they were treated and recovered without any sequel. These seizures were classified as acute symptomatic or provoked seizures. We suggest that if one faces acute repetitive seizures, especially in the rural areas, an intoxication such as endosulfan intoxication should be considered when the etiology is uncertain even in the absence of any signs of intoxication.

Background: Endosulfan is not a restricted use organochlorine insecticide and is currently under re-registration review. In 1993, one confirmed case and one possible case of endosulfan poisoning in agricultural workers occurred in two southeastern states., Methods: Two cases of suspected endosulfan poisoning were investigated utilizing record reviews, blood samples, a site visit, and clothing analysis., Results: Case 1 was fatal; Case 2 resulted in permanent neurological impairment. Additionally, Case 1 mixed and applied two less toxic pesticides, acephate and maleic hydrazide to tobacco plants. Both farm owners had ample opportunity for endosulfan exposure while mixing concentrated endosulfan with water and applying the solution to tobacco with boom sprayers pulled by tractors., Conclusions: Estimates of the absorbed dose of endosulfan were not available because methods to determine actual personal exposure that would be found in fat or tissue samples were not used. Health and safety issues associated with endosulfan require a closer examination. A cooperative multi-disciplinary approach to providing timely accurate education is needed to prevent pesticide poisonings., (Copyright 2001 Wiley-Liss, Inc.)

Objectives: The objective of the study is to identify the clinical profile of endosulfan poisoning and also to recognise any biochemical parameters which indicate clinical or subclinical dysfunction of organs so that the offending agent can be easily identified in a given case of poisoning and appropriate treatment instituted promptly., Methods: Forty four individuals who consumed food which was accidentally contaminated by endosulfan in a rural area were the subjects of the present study. Except the one who died, rest 43 were examined by the authors. A details history, regarding the item of food taken and quantity consumed was noted. Routine bio-chemical parameters like CBC, blood urea, serum creatinine, serum electrolytes, LFT, S Calcium, S Phosporus, were estimated, in fourteen of the patients who were admitted into this hospital. In seven of the patients who were available for follow up, laboratory parameters which were abnormal initially were repeated., Results: Examination revealed that vital signs were stable. There was no jaundice, central nervous system examination showed varying grades of altered sensorium, normal sized pupils briskly reacting to light, normal oculocephalic reflex. There were no lateralising signs like hemiparesis. Plantars were bilateral extensor. There were no signs of meningeal irritation. Complete blood counts, blood sugar, urea, serum creatinine, serum electrolytes were all normal. Liver function tests in the form of SGPT, SGOT were abnormal. Serum bilirubin levels were normal. The values of SGOT and SGPT returned to normal at the end of six weeks. All patients were treated symptomatically. A postmortem examination carried out on the individual who died due to status epilepticus confirmed that the death was due to asphyxia., Conclusions: Endosulfan poisoning can be suspected by the primary CNS manifestations with or without clinical or laboratory evidence of other organ dysfunction like liver, kidney and muscle.

Eighteen cases of endosulfan poisoning by accidental overexposure during spray, admitted between October 1995 to September 1997, were observed and analyzed. These accounted for approximately one third of the total number of poisoning cases admitted in our unit during this period. Nausea, vomiting abdominal discomfort, tonic and clonic convulsions, confusion, disorientation, and muscular twitchings were cardinal manifestations. None of the patients succumbed to their illness. Analysis of various incriminating factors revealed that accidental overexposure was due to failure to adhere to the instructions for spray either due to ignorance or due to illiteracy. All the patients avoided preventive measures and developed toxicity both due to inhalation and absorption through skin. Endosulfan (a chlordiene derivative) poisoning is gaining up momentum in this part of world and has become an important matter for public health in India.

Case Report: A case of nonaccidental endosulfan intoxication in a previously healthy 43-year-old male patient is reported. On admission, the patient had few symptoms, but refractory seizures began 1 hour after ingestion. The patient died on the fourth day after admission showing clinical signs of cerebral herniation confirmed at autopsy. Blood, urine, and tissue samples were analyzed for alpha-endosulfan, beta-endosulfan, and endosulfan sulfate by capillary gas chromatography with electron capture detection. Concentration versus time data for endosulfan were fitted using the program MW/Pharm, assuming complete bioavailability although it is recognized that the bioavailability of endosulfan after ingestion may have been low and the calculated clearance was primarily due to redistribution. Hemoperfusion was shown to be ineffective.

We report a teenage girl with acute endosulfan poisoning who developed psychosis, generalized tonic-clonic seizures, myoclonic jerks, cortical blindness and limb rigidity. Serial magnetic resonance imaging (MRI) showed bilateral reversible lesions localized to caudate nucleus, putamen and occipital cortex; internal capsule and thalamus were spared. This selective involvement may have a bearing on mechanisms underlying endosulfan toxicity.

Two cattle died acutely after being sprayed for lice control with a cyclodiene organochlorine insecticide, endosulfan, not labelled for use in cattle. Three other cattle became acutely ill, but survived after symptomatic therapy and removal of the insecticide from their skin and prevention of enterohepatic circulation. These cases illustrated the risk of acute toxicosis when organochlorine insecticides are used off-label and the potential for illegal tissue and milk residues.