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Bernasconi L, Carnovale M, Lonati D, Petrolini VM, Schicchi A, Brolli B, Negrini VM, Grazioli C, Maystrova O, Buscaglia E, Scaravaggi G, Crema F, Locatelli CA. Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre. Occup Med (Lond) 2023; 73:500-506. [PMID: 37948128 PMCID: PMC10756658 DOI: 10.1093/occmed/kqad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It's currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide. AIMS To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption. METHODS We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007-December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed. RESULTS Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II-III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered. CONCLUSIONS Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC's crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it's still legal.
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Affiliation(s)
- L Bernasconi
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy
| | - M Carnovale
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy
| | - D Lonati
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
| | - V M Petrolini
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
| | - A Schicchi
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Experimental Medicine PhD program, University of Pavia, Pavia 27100, Italy
| | - B Brolli
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy
| | - V M Negrini
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy
| | - C Grazioli
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
- Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy
| | - O Maystrova
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
| | - E Buscaglia
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
| | - Giulia Scaravaggi
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
| | - F Crema
- Department of Internal Medicine and Therapeutics, Section of Pharmacology, University of Pavia, Pavia 27100, Italy
| | - C A Locatelli
- Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy
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Lonati D, Giampreti A, Rossetto O, Petrolini VM, Vecchio S, Buscaglia E, Mazzoleni M, Chiara F, Aloise M, Gentilli A, Montecucco C, Coccini T, Locatelli CA. Neurotoxicity of European viperids in Italy: Pavia Poison Control Centre case series 2001-2011. Clin Toxicol (Phila) 2014; 52:269-76. [PMID: 24708390 DOI: 10.3109/15563650.2014.904046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Some clinical aspects about neurotoxicity after snakebites by European viper species remain to be elucidated. OBJECTIVE This observational case series aims to analyze neurological manifestations due to viper envenomation in Italy in order to describe the characteristic of neurotoxicity and to evaluate the clinical response to the antidotic treatment, the outcome, and the influence of individual variability in determining the appearance of neurotoxic effects. MATERIALS AND METHODS All cases of snakebite referred to Pavia Poison Centre (PPC) presenting peripheral neurotoxic effects from 2001 to 2011 were included. Cases were assessed for time from bite to PPC evaluation, Grade Severity Score (GSS), onset/duration of clinical manifestations, severity/time course of local, non-neurological and neurological effects, and antidotic treatment. RESULTS Twenty-four were included (age, 3-75 years) and represented on average of 2.2 cases/year (about 5% of total envenomed patients). The mean interval time of PPC evaluation from snakebite was 10.80 ± 19.93 hours. GSS at ED-admission was 0 (1 case), 1 (10 cases), and 2 (13 cases). All patients showed local signs: 41.6%, minor; 58.4%, extensive swelling and necrosis. The main systemic non-neurological effects were as follows: vomiting (86.7%), diarrhea (66.7%), abdominal discomfort (53.3%), and hypotension (20%). Neurotoxic effects were accommodation troubles and diplopia (100%), ptosis (91.7%), ophtalmoplegia (58.3%), dysphagia (20.8%), drowsiness (16.6%), cranial muscle weakness (12.5%), and dyspnea (4.2%). Neurotoxicity was the unique systemic manifestation in 9 cases; in 4 cases, they were associated with only mild local swelling. In 10 patients the onset of neurotoxic effects followed the resolution of systemic non-neurological effects. Antidote was intravenously administered in 19 (79.2%) patients. The mean duration of manifestations in untreated versus treated groups was 53.5 ± 62.91 versus 41.75 ± 21.18 hours (p = 0.68, local effects) and 9.77 ± 3.29 versus 8.25 ± 12.23 hours (p = 0.1, systemic non-neurological effects) and 43.4 ± 14.69 versus 26.58 ± 20.62 hours (p = 0.03, neurotoxic effects). CONCLUSIONS Neurotoxicity may appear late (11 hours after the bite in 58.3% of cases), in contrast with the data reported in medical literature. Neurotoxic effects have been reversible in all cases and may be the unique systemic manifestation of envenomation. Neurotoxic effects are shorter in treated group. The antidotic treatment of patients considered as GSS 2 only for neurotoxic effects (with mild local effects) may not be necessary. Variable factors such as different amount of venom injected, concentration of PLA2 component, and individual susceptibility may explain the less percentage of patients presenting neurotoxic effects.
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Affiliation(s)
- D Lonati
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia , Pavia , Italy
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Locatelli C, Lonati D, Buscaglia E, Vecchio S, Giampreti A, Petrolini V, Chiara F, Aloise M, Cortini E, Papa P, Rolandi L, Rocchi L, Rimondo C, Seri C, Serpelloni G. “Synthe-tic co-caine” as legal cocaine hides synthetic cannabinoids. Toxicol Lett 2013. [DOI: 10.1016/j.toxlet.2013.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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