Rodenticide poisoning as a cause of quadriparesis: a rare entity.

Acute flaccid paralysis with its wide repertoire of causes presents a challenge to the clinician. We present a case of barium carbonate poisoning, a rare yet easily treatable cause of acute quadriparesis. Barium acts by redistribution of potassium from the extra- to intravascular compartment causing hypokalemia. Early recognition and prompt potassium supplementation under cardiac monitoring yield gratifying results.

Barium carbonate poisoning mimicking Guillain-Barre syndrome.

Areflexic quadriplegia due to barium carbonate (rat poison) poisoning is described in two young patients. These cases very closely resembled Guillain-Barre syndrome. The various effects of barium carbonate along with the pathogenesis of hypokalaemic paralysis are highlighted.

Sodium sesquicarbonate toxicity in broiler chickens.

A case of feed misformulation resulted in the addition of sodium sesquicarbonate (SSC) into broiler chicken feed. SSC is a buffering agent used in the manufacture of high urea ruminant feeds that were also produced in this feed mill. Within 2 days of receipt of the tainted broiler feed on the farm, chickens were exhibiting polydypsia and wet droppings and had increased levels of mortality. The postmortem lesions were dehydration, fluid-filled intestines, swollen, pale kidneys, and visceral urate deposits. Histopathology of the kidneys revealed dilated tubules with a giant cell response, loss of tubular epithelium, and a few needlelike crystals. The mortality within 4 days of exposure in three severely affected houses reached 17%. An analysis of the feed revealed sodium levels ranging from 2.59% to 4.88%, with chloride levels of 0.24%-0.40%. Ten percent of the ration was thought to be SSC that contains 36% sodium. To determine if the presence of the SSC caused the problems observed, a controlled study was undertaken. One hundred fifty 3-wk-old broilers were evenly distributed into three floor pens. One group was fed a normal grower ration, a second group was fed a ration containing 5% SSC, and a third group received a ration with 10% SSC. Mortality, packed cell volumes (PCV), total serum proteins, and histopathology of the kidneys were determined. The 10% SSC group had a 6% mortality. Dehydration was evident by elevated PCV within 1 day of ingestion of either ration containing SSC. Microscopic lesions in the kidney were more severe in chickens ingesting SSC when compared with control groups.

Simple, rapid and simultaneous measurement of eight different types of carbamate pesticides in serum using liquid chromatography-atmospheric pressure chemical ionization mass spectrometry.

We have developed a method for simultaneous analysis of methylcarbamate pesticides in serum with an acute pesticide intoxication. This is performed by liquid chromatography-atmospheric pressure chemical ionization mass spectrometry. Rapid detection of eight types of methylcarbamate pesticide can be achieved with this method, it only requires an extremely simple pre-treatment of the sample. The specificity of this method is equal to that of gas chromatography-mass spectrometry, and it satisfies the clinical requirements for detection sensitivity and specificity. Although some problems with this analytical method remain to be solved, we consider it to be superior to any other analytical method previously reported.

Dermatitis caused by dimethyl cyanocarbonimidodithioate.

Dimethyl cyanocarbonimidodithioate (CAS No. 10191-60-3) a raw material for cimetidine synthesis, is labelled as an irritant on its storage tank. There is no information available regarding the toxic effects of human exposure. We report a case of severe dermatitis clinically resembling erythema multiforme following an accidental exposure to dimethyl cyanocarbonimidodithioate in an occupational setting. A clerk sifted a handful of dimethyl cyanocarbonimidodithioate from an unlabelled bucket through his bare hands during an inspection prior to customs clearance. Five hours later, while he was washing his hands, pruritus, erythema and vesicles developed over the exposed area. The skin condition worsened within two weeks, extending to his whole body with generalized erythema and vesicles of various sizes. Some vesicles became confluent with ruptured bullae, resembling a second degree burn over 40% of the body. Elevation of the serum IgE (705 mu/mL, normal less than 300 mu/mL) and lymphocyte activation with an increased 3H-thymidine uptake by the patient's mononuclear cells suggested that this episode resulted from a cell-mediated allergic skin reaction. The skin lesions improved progressively after systemic steroid therapy for about two weeks. Dimethyl cyanocarbonimidodithioate is used as a raw material for cimetidine synthesis by some pharmaceutical manufacturers. Our experience suggests that a severe reaction similar to that caused by another H2-blocker, ranitidine and its intermediate may be caused by dimethyl cyanocarbonimidodithioate in occupational exposures. Systemic steroid administration is beneficial in treatment.