On February 21, 2013, 6 elderly people collapsed abruptly after eating bean sprout bibimbab (boiled rice mixed with bean sprouts and seasoned with soybean sauce) at a countryside restaurant in the Chungbuk Province, Korea. Minutes after eating the meal, all of the patients lapsed into a state of stupor. Respiratory arrest developed in 2 patients; and one of two patients died of cardiac arrest. The autopsy identified methomyl and methanol in the deceased patient's gastric contents and in the remaining soybeanbean sauce seasoning. Five of the 6 patients ingested one spoonful of the soybeanbean sauce seasoning and survived, while one patient who died of cardiac arrest, ingested approximately two spoons. Symptoms of toxicity presented quickly in the subjects and progressed rapidly, including chest tightness, an unusual sensation in the pit of the stomach, dizziness, ataxia, and finally, collapse. Three patients who drank ethanol with the meal experienced only mild toxic symptoms. Our analysis of the clinical observations in these cases suggests that ingestion of methomyl pesticide and the additive toxicity of methanol may have been responsible for the intoxication.
Aged ; Cholinesterase Inhibitors/poisoning ; *Disease Outbreaks ; Ethanol ; Female ; Foodborne Diseases/*epidemiology ; Humans ; Insecticides/*poisoning ; Male ; Methanol/*poisoning ; Methomyl/*poisoning ; Republic of Korea/epidemiology

OBJECTIVETo study the neuromuscular function and its relation with the occurrence of myasthenia in rats poisoned by dimethoate (D), phoxim (P), methomyl (M), M + D and M + P respectively.

METHODSThe stimulation single fiber electromyography(SSFEMG) at different stimulus frequencies(5, 10 and 20 Hz) was used. The whole blood cholinesterase (ChE) activity was measured 1 h before and after poisoning.

RESULTS(1) Myasthenia occurred in 5 out of 9.5 out of 10.5 out of 5, and 8 rats poisoned by D, P, M + D, and M + P, respectively. (2) The average mean consecutive differences(MCD) at 5, 10, and 20 Hz in myasthenic rats were significantly higher than those of poisoned rats without myasthenia and the control ones. (3) SSFEMG changes at 5, 10 and 20 Hz were significantly consistent with the clinical manifestation of myasthenia, especially at 10 Hz and 20 Hz. (4) ChE activity was significantly lower in rats with P or D poisoning while ChE inhibition was of no difference in rats with M, M + D, and M + P poisoning. In the D poisoning and P poisoning groups, there was no significant difference in ChE inhibition between the rats with and without myasthenia.

CONCLUSIONMuscle weakness was associated with neuromuscular transmission dysfunction, but not well correlated with ChE inhibition. The SSFEMG with stimulus frequency at 10 Hz or 20 Hz could be used to detect the neuromuscular dysfunction during myasthenia induced by organophosphate insecticides and their mixtures poisoning.

Animals ; Cholinesterase Inhibitors ; poisoning ; Dimethoate ; poisoning ; Electromyography ; Insecticides ; poisoning ; Methomyl ; poisoning ; Muscle Weakness ; chemically induced ; Myasthenia Gravis ; chemically induced ; physiopathology ; Neuromuscular Junction ; drug effects ; physiology ; Organothiophosphorus Compounds ; poisoning ; Rats ; Synaptic Transmission ; drug effects

BACKGROUND: Organophosphate and carbamate insecticides have been used extensively in agriculture resulting in serious increases in poisoning. Levels of poisoning by carbamates and organic phosphorus compounds and the severity of associated symptoms are dependent not only on the degree of reduction of acetylcholinesterase activity in the nervous system but also on the rate of inhibition and the type of inhibitive action. The most striking differences between the clinical effects of the two groups of compounds are the much more rapid and spontaneous recovery from poisoning by carbamates and the relatively large difference between the smallest dosage of any carbamate that will cause mild illness and the lethal dosage of the same compound. The purpose of this study is to compare the clinical characteristics of acute intoxication by organophosphate and carbamate insecticides. METHOD: We retrospectively analyzed the clinical characteristics of 41 patients poisoned with organophsphates and 12 patients poisoned with carbamates, who were admitted to the department of internal medicine, Soonchunhyang Chunan hospital from January 1995 to December 1996. RESULTS: 1) The most common organophosphate was EPN (9 cases) followed by Dichlorvos (7 cases). In the carbamates group, Carbofuran (5 cases) was the most common followed by Methomyl (3 cases).2) The main cause of poisoning was ingestion for the purpose of suicide in both groups.3) The severity of poisoning was more acute in the organophosphate group than in the carbamate group.4) Altered consciousness and respiratory depression occurred more frequently in the organophosphate group than in the carbamate group. Six cases out of the organophosphate group suffered from respiratory depression 24 hours to 96 hours after poisoning.5) The activity of serum cholinesterase showed no significant difference between poisoning with organophosphates and with carbamates.6) The mortality rate was 22% in organophosphate intoxication and 16.7% in carbamate intoxication. The most common complication of organophosphate and carbamate intoxication was aspiration pneumonia. CONCLUSION: Carbamate insecticides exhibited less toxicity than organophosphates.
Acetylcholinesterase ; Agriculture ; Carbamates ; Carbofuran ; Cholinesterases ; Chungcheongnam-do ; Consciousness ; Dichlorvos ; Eating ; Humans ; Insecticides* ; Internal Medicine ; Methomyl ; Mortality ; Nervous System ; Organophosphates ; Phosphorus Compounds ; Pneumonia, Aspiration ; Poisoning* ; Respiratory Insufficiency ; Retrospective Studies ; Strikes, Employee ; Suicide

PURPOSE: To investigate the age group characteristics of children who visited the emergency department with acute poisoning by ingestion. METHODS: We reviewed children under 19 years who visited the emergency department for acute poisoning by ingestion from 2012 to 2017. The children were divided into 3 age groups; infants (0-1 years), preschoolers (2-5 years), and schoolers (6-18 years). Clinical characteristics, intentional ingestion, involved substances (drugs, household products, artificial substances, and pesticides), decontamination and antidote therapy, and outcomes of the 3 age groups were compared. We also performed multivariable logistic regression analysis to identify factors associated with hospitalization. RESULTS: A total of 622 children with acute poisoning by ingestion were analyzed. Their annual proportions to overall pediatric emergency patients ranged from 0.3% to 0.4%. Age distribution showed bimodal peaks at 0-2 years and 15-17 years. The infants showed lower frequency of girls, intentional ingestion, ingestion of drugs, performance of decontamination and antidote therapy, and hospitalization than 2 older groups (P < 0.001). Most decontamination, antidote therapy, and hospitalization occurred in the schoolers (P < 0.001). The most frequently reported substances were household cleaning substances in the infants (18.2%), antihistamines in the preschoolers (15.8%), and analgesics in the schoolers (37.5%). The factors associated with hospitalization were intentional ingestion (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 2.85-17.61; P = 0.001) and schoolers (aOR, 2.33; 95% CI, 1.10-7.53; P = 0.031; compared with infants). Only 1 in-hospital mortality was found in a boy aged 2 years who ingested methomyl. CONCLUSION: Infants may experience non-intentional ingestion, ingestion of non-pharmacologic substances (especially household cleaning substances), discharge without decontamination and antidote therapy more frequently than older children. Thus, we need age group-specific, preventive and therapeutic plans for children with acute poisoning.
Adolescent ; Age Distribution ; Analgesics ; Child ; Decontamination ; Eating ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Family Characteristics ; Female ; Histamine Antagonists ; Hospital Mortality ; Hospitalization ; Household Products ; Humans ; Infant ; Logistic Models ; Male ; Methomyl ; Odds Ratio ; Poisoning