Status epilepticus after C-4 ingestion: using liquid chromatography to quantify toxicity

Area of Science:

• Toxicology
• Neurology
• Military Medicine

Background:

• C-4 explosive, containing cyclotrimethylenetrinitramine (RDX), is sometimes ingested by soldiers.
• RDX ingestion can cause severe neurological symptoms, including convulsions and encephalopathy.
• Assessing RDX toxicity in clinical settings presents diagnostic challenges.

Observation:

• A 22-year-old soldier presented with status epilepticus after C-4 ingestion.
• Standard anti-epileptic treatments were minimally effective.
• Continuous propofol, lacosamide, and levitiracetam were required to control seizures.

Findings:

• Serum RDX levels were measured using high-performance liquid chromatography (HPLC).
• Peak RDX concentration was 3.06 μg/ml.
• RDX levels decreased to 2.43 μg/ml as seizures resolved.

Implications:

• This is the first reported case of measurable RDX toxicity over time in a human.
• C-4 poisoning should be considered in soldiers presenting with sudden seizures.
• Early recognition and management of RDX toxicity are crucial.