Acute hydrogen cyanamide [Dormex] toxicity: an outbreak in El-Minia governorate; a prospective study

ABSTRACT

The aim of this study is to assess the acute toxic effects of Hydrogen Cyanamide, the active ingredient in Donnex which is a plant growth regulator, in human and to estimate the magnitude of hydrogen cyanamide-related illnesses in our locality [El-Minia govemorate- Upper Egypt]. Symptomatic cases involving acute Dormex exposure during the outbreak period [From January 2009 to March 2009] that were presented to the Poison Control Centre [PCC], El-Minia University Hospital and El-Minia general hospitals were included in this study. In each patient, a detailed history regarding age, sex, residence, route and mode of exposure, symptoms, signs and complications were taken at the time of presentation. A thorough clinical examination was then carried out. Laboratory investigations were done for random blood sugar [R.B.S], serum sodium and potassium levels, liver enzymes aspartate aminotransferase, and alanine aminotransferase [AST and ALT respectively], blood urea nitrogen [BUN], and serum creatinine. Chest X ray was also done for every case of this work. The study was conducted on 43 patients of both sexes with acute Donnex toxicity in addition to 10 healthy individuals of both sexes, representing the basic profile for the studied laboratory parameters. The majority of cases were below 20 years. Gender distribution revealed that a male to female ratio was about 2.6 1. Patients from rural areas represent [83.7%] while [16.3%] were from urban areas. Exposures were either occupational [67.0%] or as a result of unintentional ingestion [30.2%]; and only one case were related to suicide attempt. All cases occurred from early January through March of the year 2009, which is the period when Dormex [CH2N2] was being applied to the grape trees in our district. The routes of exposure to Dormex CH2N2 were skin contact [60.5%], oral ingestion [32.6%], and inhalation [6.9%]. Most of the cases involved workplace exposure [67.5%]. Dermatological manifestations were evident in the vast majority of cases [67.4%], while ocular manifestations were noted in [39.5%] of the patients. [67.4%] of patients had systemic signs and/or symptoms, including GIT manifestations, CNS manifestations, pulmonary manifestations, and cardiovascular manifestations. Five deaths from the 43 cases were identified. Statistically significant hyperglycemia and elevation in hepatic enzymes profile were noted on admission in all patient groups in comparison to control group, while there were no statistically significant changes observed in serum electrolytes and renal function tests in all patients at time of admission in comparison with control subjects. Based on the current study, acute exposure to Dormex, either dermally in the workplace or by ingestion in those using this product, pose a major threat to human health in the form of hepatic dysfunction, prolonged coma, and severe respiratory and gastrointestinal affections. The study recommended that all efforts should be directed towards studying the possible acute and chronic toxic effects of Dormex on human health in more expanded, large scale clinical and experimental studies