Death in a toddler following endosulfan ingestion

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.

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.

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.

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.