Here, we report the poisoning case of 10 cows. Several distinct clinical signs such as convulsion, excessive salivation, circling, lateral recumbency, and death were observed. Necropsy and histopathological examination did not reveal any significant abnormal findings. Moreover, no bacteria or viruses were detected in tissue, blood, and feeding food. However, endosulfan was detected from the stomach contents and microbials. Our results strongly suggest that death of cows may be closely associated with endosulfan poisoning.
Animals ; Bacteria ; Cattle* ; Endosulfan* ; Gastrointestinal Contents ; Poisoning* ; Salivation ; Seizures

Endosulfan is an agricultural chemical of organic chlorine, is toxic in both the central nervous system and the cardiovascular system, and causes respiratory system disorder and deaths by status epilepticus, respiratory distress, and so on. The use of this agricultural chemical of organic chlorine is limited by its toxicity. However, it is still used as a common insecticide, so it is readily to available. Four elderly people were admitted with depression of consciousness and convulsions after eating pan-fried food. During their treatment, the patients were diagnosed with endosulfan intoxication, completely by accident. We are reporting these cases of endosulfan intoxication that showed variable clinical findings from mild sequelae to death.
Aged ; Cardiovascular System ; Central Nervous System ; Chlorine ; Consciousness ; Depression ; Eating ; Endosulfan* ; Humans ; Respiratory System ; Seizures ; Status Epilepticus

PURPOSE: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. METHODS: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. RESULTS: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. CONCLUSION: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.
Acute Kidney Injury ; Adult ; Anticonvulsants ; Emergencies ; Emergency Service, Hospital ; Endosulfan* ; Humans ; Mortality ; Poisoning* ; Retrospective Studies ; Rhabdomyolysis ; Seizures ; Shock ; Status Epilepticus

OBJECTIVES: To establish an analytical method of the endosulfan concentrations （α-endosulfan and β-endosulfan） in biological samples by GC-MS/MS. To observe the distribution of endosulfan in aquatic animals and provide experimental evidence for forensic identification of relevant cases. METHODS: Acetonitrile was added to the blood and muscle samples for precipitating the protein. The endosulfan concentrations were determined by GC-MS/MS in multiple reaction monitoring mode. Qualitative analysis was performed according to the retention time and ion rate, and quantitative analysis was performed by external standard working curve method. RESULTS: In blood samples, the calibration curves of α-endosulfan and β-endosulfan ranging from 0.062 5 to 10 μg/mL had good linear relationship, the correlation coefficients （r） of which were >0.99. The limits of detection （LOD） were 1 ng/mL and 2 ng/mL and the limits of quantification （LOQ） were 4 ng/mL and 8 ng/mL, respectively. In muscle samples, the calibration curves of α-endosulfan and β-endosulfan ranging from 0.062 5 to 10 μg/g, the r of which were >0.98. The LOD were 1 ng/g and 4 ng/g and the LOQ were 4 ng/g and 16 ng/g, respectively. The accuracy of α-endosulfan and β-endosulfan was 90.76%-108.91% both in blood and muscle samples, the interday and intraday precision were 2.35%-8.71% and 5.44%-10.29%, respectively. In poisoning cases, endosulfan were detected in all parts of fish and crab and the content difference was statistically significant. CONCLUSIONS The endosulfan detection method based on GC-MS/MS established in the present study is rapid, sensitive and accurate, which can be applied to the endosulfan detection in traces biological samples. The distribution of endosulfan in fish and crab was different, which can provide evidence to the sample collection and analysis for toxicological analysis in relevant forensic identification.
Animals ; Chromatography, Gas/methods* ; Endosulfan/metabolism* ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Limit of Detection ; Reproducibility of Results ; Tandem Mass Spectrometry/methods*

During the past decades, advancement in pubertal onset especially in girls has been noticed worldwide. Genetic factors and increasing prevalence of adiposity may contribute, however ubiquitous presence of endocrine disrupting chemicals (EDCs) is suspected to be involved in the trend of earlier pubertal onset. Most of known EDCs have estrogenic and/or anti-androgenic actions and few have androgenic or anti-estrogenic effects. Some studies reported earlier age at menarche after exposure to polycholorinated biphenyls (PCBs), polybrominated biphenyls, dicholordiphenyltrichloroethane, phthalate esters, while several other studies found no effect of these compounds on Tanner stages or age at menarche in girls. Limited studies reported an association of delayed puberty in boys and exposure to PCBs or the pesticide endosulfan. However, epidemiological research on the effects of EDCs on sexual maturation is hampered by many pitfalls, such as the mixture of many chemicals with different effects in environment, unidentified critical window of exposure, and limited knowledge about the time lag between exposure and effect. In this paper, we reviewed possible mode of actions of different chemical compounds, and summarized animal/human studies shown the effects of EDCs on the pubertal development.
Adiposity ; Endocrine Disruptors ; Endosulfan ; Esters ; Estrogen Receptor Modulators ; Estrogens ; Female ; Menarche ; Phthalic Acids ; Polybrominated Biphenyls ; Polychlorinated Biphenyls ; Prevalence ; Puberty ; Puberty, Delayed ; Sexual Maturation

Adolescent ; Adult ; Aged ; Aspartate Aminotransferases ; metabolism ; Case-Control Studies ; Electrocardiography ; Endosulfan ; poisoning ; Female ; Humans ; Lactate Dehydrogenases ; metabolism ; Male ; Middle Aged ; Young Adult

PURPOSE: Although endosulfan is a highly toxic compound that is responsible for a number of severe intoxications and deaths, there are no specific antidotes for endosulfan poisoning. Most fatalities due to endosulfan ingestion have symptoms that develop within 4~6 hours after ingestion, and to improve survival chances it is important to recognize those patients with a poor prognosis as early as possible and to institute aggressive treatment. Therefore we sought to identify the factors that predict death in patients with endosulfan ingestion. METHODS: We enrolled 58 patients who were over 18 years and who presented to Chonnam National University Hospital with ingestion of endosulfan from January 2001 to June 2007. These patients were divided into two groups according to survival. The baseline characteristics, initial results of laboratory tests, the occurrence of complications, and the duration of hospitalization were collected. RESULTS: The fatality rate of endosulfan was 30.2%. The most common cause of death in the non-survival group was refractory status epilepticus. The patients in the non-survival group showed significantly lower blood pressure, arterial pH, base excess, and bicarbonate, and a significantly higher level of arterial carbon dioxide, sodium, and potassium than the survival group. In a multivariate analysis, the independent factors were arterial pH and the amount ingested. CONCLUSION: Endosulfan is a highly harmful pesticide with a fatality rate over 30%. The factors that predict death during hospitalization are arterial pH on admission and amount ingested. The physician must start an aggressive treatment, including early administration of the appropriate anticonvulsant, when a patient presents to the ER with these characteristics.
Antidotes ; Arterial Pressure ; Carbon Dioxide ; Cause of Death ; Eating ; Endosulfan ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Multivariate Analysis ; Potassium ; Prognosis ; Sodium ; Status Epilepticus

PURPOSE: The unrestricted use of endosulfan results in many cases of intentional and unintentional poisoning, mainly in developing countries. We report our experience with the clinical features of endosulfan poisoning. METHODS: Fifteen patients with endosulfan exposure who came to our emergency department (ED) during the study period were retrospectively enrolled. Toxicological history, toxic symptoms and signs, and laboratory test results were collected from the ED medical records. The patients were classified into two groups according to the presence or absence of seizures. The quantitative data and dichotomous variables were compared between the two groups. RESULTS: The 15 patients, 9 women and 6 men, had a mean age of 54.7 years. Most of the poisonings (13 patients, 86.7%) stemmed from deliberate self-harm, while the other two were unintentional. The patients were categorized into seizure (10 patients) and no-seizure (5) groups. After the acute phase of toxicity, complications were observed in 9 patients and all of them belonged to the seizure group. Eight patients in the seizure group progressed to status epilepticus and needed mechanical ventilatory support. Four of these patients (50%) subsequently died. The duration of hospital stay was 8.5 days in the seizure group and 3.0 days in the no-seizure group. White blood cell counts, blood glucose, and enzyme function tests for the liver, pancreas, heart, and muscles were abnormally increased in the seizure group, all occurring within the initial 24 hours after the onset of seizure. Severe metabolic acidosis was also present in the seizure group. CONCLUSION: Seizure or status epilepticus accompanied by involvement of several organs was distinctive feature of endosulfan exposure/poisoning. Therefore, emergency physicians who practice in agricultural areas should have a high index of suspicion when treating patients presenting with acute repetitive seizure, accompanied by gastrointestinal complaints and laboratory evidence of multiple organ dysfunction including metabolic acidosis.
Acidosis ; Blood Glucose ; Developing Countries ; Emergencies ; Endosulfan ; Female ; Heart ; Humans ; Length of Stay ; Leukocyte Count ; Liver ; Male ; Medical Records ; Muscles ; Pancreas ; Porphyrins ; Retrospective Studies ; Seizures ; Self-Injurious Behavior ; Status Epilepticus

PURPOSE: In highly doses, endosulfan lowers the seizure threshold and elicits central nervous system stimulation, which can result in seizures, respiratory failure, and death. Management of seizure control is essential for survival and prognosis of intoxicated patients. This study assessed whether seizure time was an independent predictor of mortality in patients with endosulfan poisoning. METHODS: This retrospective study enrolled patients with endosulfan poisoning presenting to Masan Samsung Hospital and Gyeongsang National University Hospital from January 2003 to December 2008. The data were collected from clinical records and laboratory files. Using a multivariate logistic analysis, data on the total population was retrospectively analyzed for association with mortality. RESULTS: Of the 24 patients with endosulfan poisoning, nineteen (79.1%) experienced seizure. The patients in the seizure group showed significantly lower Glasgow coma scale score, base excess, bicarbonate, and significant existence of mechanical ventilation, as compared to the non seizure group (n=5). Seizure, Glasgow coma scale score, systolic blood pressure, bicarbonate level, need for respiratory support, pulse rate, respiratory rate, pH, base excess, and seizure time were associated with mortality. The fatality rate of endosulfan poisoning was 54.1% with higher mortality among patients experiencing. Longer seizure time was associated with higher mortality. CONCLUSION: Seizure time can be a significant independent predictor of mortality in patients with acute endosulfan poisoning. Physicians should aggressively treat for seizure control in patients with acute endosulfan poisoning.
Blood Pressure ; Central Nervous System ; Endosulfan ; Glasgow Coma Scale ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Nitroimidazoles ; Prognosis ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Rate ; Retrospective Studies ; Seizures ; Statistics as Topic ; Sulfonamides