ABSTRACT

Management of endosulfan induced intoxication in a patient with refractory status epilepticus.

A 17-year-old patient was admitted to the pediatric emergency department due to loss of consciousness, vomiting, seizure and dispnea after ingestion of endosulfan for suicidal purpose. His blood gas was acidotic with a pH of 6.96, and his myoglobin level was 534 ng / ml. The rest of his blood gas was as follows: (PaO2: 86 mmHg, PaCO2: 41 mmHg, HCO3¯: 9.3 mmol/L, BE: -22.5). Patient was diagnosed with endosulfan poisoning by available clinical and laboratory findings. Despite administration of intermittent midazolam for generalized tonic clonic seizure activity, seizures persisted, and patient was loaded with phenytoin and then levetiracetam. His midazolam infusion was increased to 0.9 mg / kg / h. Due to refractory seizure activity, patient was started on thiopental sodium infusion, which was titrated up to 5 mg / kg / h. During follow- up seizures did not recur, and antiepileptic therapy was discontinued gradually. With clinical and laboratory improvement patient was discharged on the seventeenth day of admission.

Refractory status epilepticus is rare in endosulfan intoxications. Treatment should be symptomatic, and close observation and monitoring is required due to the high mortality risk.

Keywords: Endosulfan, seizures, poisoning