Outcome of sixty four cases of ethylene dibromide ingestion treated in tertiary care hospital

BACKGROUND AND AIMS

In view of high incidence and mortality due to ethylene dibromide poisoning, a prospective study was planned to assess demographic, toxicological, clinical profile and outcome.

MATERIAL AND METHODS

Prospectively collected data of sixty four patients with ethylene dibromide poisoning were reviewed. All the patients were from Gwalior and neighbouring districts.

RESULTS

Majority were males in the age group 21-30 years. Out of sixty-four cases 26 patients (40.6%) survived and 38 patients (59.4%) expired. Nausea vomiting and pain abdomen were most common symptoms at presentation. Diarrhoea, drowsiness, palpitations and oliguria were other features. Pulse rate was normal (< 100) in 22 (84.6%) survived patients whereas it was > 100 in 24 (63.1%) of expired patients at the time of admission (p value = 0.0004199). Half ampoule (1.5ml.) of ethylene dibromide was sufficient as fatal dose. Mortality was 20% and 46.15% with half and one ampoule respectively. Best outcome was when the patient presented to the hospital within six hours. Death occurred anywhere between twelve hours and five days. Gastrointestinal toxicity was predominant at presentation. Nausea, vomiting and abdominal pain was present in all the patients. Nephrotoxicity 32 (50%), hepatotoxicity 28 (43.8%), cardiotoxicity 28 (43.8%), central nervous system 8 (12.5%) toxicity and hypoglycemia 24 (37.5%) were also observed.

CONCLUSION

Ethylene dibromide is highly toxic. Patients who consumed half to one ampoule usually survived with supportive care provided they presented to the hospital within six hours. Pulse rate more than 100 at presentation was a poor prognostic factor. Patients with normal pulse and blood pressure at admission had better prognosis.

Two cases of ethylene dibromide poisoning

Ethylene dibromide (EDB) is commonly available as a liquid pesticide for use as fumigant and preservative for storage of cereals and grains in India. Accidental or suicidal ingestion is often associated with often fatal delayed sudden hepatic or renal failure. We report 2 cases of EDB poisoning in humans.

Non-fatal ethylene dibromide ingestion

Ethylene dibromide (1,2-dibromoethane) is widely used to fumigate grain and fruit in India. However, acute poisoning due to it has rarely been reported in the literature and most of these patients had an fatal outcome. We describe the suicide attempt of a young male who ingested an ampoule (3 ml) of it, developed acute hepatic and renal failure, metabolic acidosis and coagulopathy but survived following supportive measures.

1,2-dibromoethane--a toxicological review

DBE is transported in the UK in road tankers and there is always the possibility of an accident. The consequences could be serious, since this chemical is absorbed by all routes, rapidly penetrates clothing and there is no effective antidote. Severe cases of poisoning are difficult to treat and there is a high mortality. Prevention of exposure is therefore essential.

Ethylene dibromide poisoning with acute renal failure: first reported case with non-fatal outcome

Ethylene-di-bromide is a popular fumigant. Delayed long-term effects of this chemical include carcinogenicity and genotoxicity in animals. Only a few cases of acute ethylene-di-bromide toxicity have been reported and all of them have resulted in a fatal outcome. We report the first case of ethylene-di-bromide poisoning presenting with acute renal failure and toxic hepatitis that was managed successfully.

The use of new field methods of semen analysis in the study of occupational hazards to reproduction: the example of ethylene dibromide

Increasing attention has been paid to the use of semen analysis as an indicator of exposure to potential mutagenic and reproductive hazards. In the infertility clinic setting, semen evaluations include the measurement of sperm concentration, volume, pH, motility, velocity and morphology, the analysis of seminal plasma to evaluate accessory sex gland function and, in some cases, the in vitro evaluation of fertilization capacity and sperm-cervical mucus interaction (Ann Intern Med 1985;103:906-919). To date, however, the study of semen characteristics of occupationally exposed populations has been confined principally to the measurement of sperm concentration and sperm morphology. This has been largely due to the unavailability of portable equipment suitable for the measurement of other semen characteristics and the difficulty of obtaining fresh semen samples in the field setting. National Institute for Occupational Safety and Health researchers have developed mobile laboratory facilities which enable us to evaluate fresh samples, in the field, for semen characteristics in addition to concentration and morphology. This paper describes the application of these methods using the example of our recent cross-sectional study of workers occupationally exposed to ethylene dibromide in the papaya fumigation industry. We discuss our findings in the context of the usefulness of semen analysis as an indicator of occupational hazards to male reproduction.

Two fatalities after acute occupational exposure to ethylene dibromide

A worker collapsed while working inside a tank that was later found to contain residues of ethylene dibromide. He died 12 hours later with metabolic acidosis, depression of the CNS, and laboratory evidence of liver damage. A supervisor attempting to rescue the first victim also collapsed inside the tank and died 64 hours later with intractable metabolic acidosis and hepatic and renal failure. The clinical, pathological, and toxicological findings, as well as results of industrial hygiene sampling, are reported. Pathophysiological mechanisms and possible therapeutic interventions are discussed. The cases demonstrate the extreme hazards of exposure to the highly toxic chemical. The importance of protective work practices wherever there is potential exposure to ethylene dibromide is emphasized.