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Severe propanil [N-(3,4-dichlorophenyl) propanamide] pesticide self-poisoning
Michael Eddleston1, Manjula Rajapakshe, Darren Roberts
1Ox-Col Collaboration, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. eddlestonm@eureka.lk
Background:
Propanil pesticide poisoning can produce methemoglobinemia, tissue hypoxia, and depression of central nervous system and respiratory system. It has been recorded only rarely worldwide and most current poison texts consider propanil to be of low toxicity. However, propanil self-poisoning is a significant clinical problem in parts of Sri Lanka and an occasional cause of death.
Aim Of Study:
To report the clinical features and management of severe propanil poisoning.
Patients And Methods:
We report a retrospective case series of patients who were treated in the intensive care unit of and/or died in Anuradhapura General Hospital between 1998 and early 2002.
Results:
Sixteen patients were identified. Common manifestations of toxicity included confusion, reduced conscious level, cyanosis, and respiratory depression. Marked hemolysis was noted in several patients. Nine deaths occurred due to respiratory depression and cardiorespiratory arrest. Management was difficult given the lack of i.v. methylene blue, inability to measure methemoglobin levels, and paucity of intensive care unit beds.
Conclusions:
This series indicates that propanil poisoning can be a severe form of self-poisoning, particularly in resource-poor settings. We have now initiated the establishment of a prospective series of propanil poisoned patients to further describe its clinical features, responsiveness to therapy, and case fatality rate.