Delayed myelosuppression with acute exposure to hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and environmental degradation product hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) in rats

Peer Pressure = Explosive Consequences: A Case Report of Toxic Ingestion of Cyclonite (C-4) Explosive on a Dare

Introduction

We present a case of intentional ingestion of a piece of plastic explosive in a military patient that resulted in tonic-clonic seizure and gastrointestinal illness.

Case Report

Although uncommon, such ingestions have been reported in military journals since the Vietnam War. Access to plastic explosives is generally limited to military personnel, and non-military medical providers may not be familiar with treatment of acute intoxication.

Conclusion

It is imperative to refresh awareness and provide education to heighten suspicion and broaden differential diagnosis for patients presenting with new onset syncope or seizure, particularly in the military population.

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

Context: C-4, a commonly used explosive in military operations, is sometimes consumed by soldiers as a rite of passage. The primary component of C-4 is cyclotrimethylenetrinitramine, or Research Department Explosive (RDX), which causes euphoria along with nausea, vomiting, renal injury, encephalopathy and convulsions when consumed in toxic amounts. We present a case of status epilepticus caused by known ingestion of C-4, in which serum levels of the compound were measured with high-performance liquid chromatography (HPLC). Case details: A 22-year-old active-duty male with no prior medical history was brought to the ED with convulsions that only minimally improved traditional anti-epileptic treatment. EEG showed persistent epileptiform activity despite initial management. Continuous propofol infusion, lacosamide and levitiracetam eventually broke the seizures. The patient eventually reported consuming a piece of C-4 four hours prior to the start of his seizure activity. Results: HPLC showed a peak RDX concentration of 3.06 μg/ml. RDX concentration at cessation of seizure activity was 2.43 μg/ml. Conclusion: Per our review of the literature, this is the first case where the explosive's toxicity could directly be measured over time in a human patient. C-4 poisoning must be considered when assessing sudden onset epileptiform activity in soldiers with access to this substance.

Megakaryocyte expansion and macrophage infiltration in bone marrow of rats subchronically treated with MNX, N-nitroso environmental degradation product of munitions compound RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine)

Hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX), environmental degradation product of munitions hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), causes seizures in rats with acute oral exposure like parent RDX. Our previous studies have additionally reported hematotoxicity with acute MNX exposure manifested as myelosuppression, anemia and splenic hemosiderosis. This study explored whether MNX administered subchronically continued to target bone marrow to elicit peripheral blood cytopenia. Female Sprague-Dawley rats were gavaged daily for 4 or 6 weeks with 47 mg kg^-1  day^-1 MNX (¼ LD₅₀ ) or vehicle (5% dimethyl sulfoxide in corn oil) and hematological and clinical chemistry parameters, spleen weights, spleen and bone marrow histopathology and immunohistochemistry with ED1 anti-CD68 macrophage marker were evaluated 24 h after the last dose. Unexpectedly, no decrease in blood erythroid parameters was seen with subchronic MNX and convulsions and tremors ceased after 2 weeks of treatment. Toxicological effects observed were MNX-induced increases in blood granulocyte and platelet counts and in bone marrow megakaryocyte and ED1⁺ -macrophage density. MNX was without effect on bone marrow cellularity and picrosirius red stained/collagen fiber deposition. Spleen weight increased modestly with extramedullary hematopoiesis evident, but hemosiderin and relative red and white pulp areas were unaffected. Collectively, this study demonstrated that erythroid effects characteristic of acute MNX exposure were not evident with subchronic exposure. However, megakaryocyte proliferation in bone marrow coincident with thrombocytosis after subchronic MNX exposure suggested continued hematotoxicity, but with a qualitatively different outcome. Granulocytosis and increased bone marrow macrophages implicated an inflammatory component in MNX hematotoxicity. Copyright © 2017 John Wiley & Sons, Ltd.