A Case of Cartap Hydrochloride Poisoning
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Cartap hydrochloride is a moderately hazardous nereistoxin insecticide that is increasingly used for deliberate self-harm in India. It can cause neuromuscular weakness resulting in respiratory failure. Published in the Journal of the Association of Physicians of India, the authors eport a patient with 4% Cartap hydrochloride poisoning who required mechanical ventilation for 36-hours. He recovered without any neurological deficits.

A 30-year old male presented with a history of deliberate consumption of an unknown substance mixed with alcohol. Initial complaints included increased salivation, sweating and vomiting. He was given gastric lavage at a local hospital. Suspecting organophosphate poisoning, atropine was administered. Within 4-hours, he required intubation for dipping sensorium and hence transferred to our hospital. His family subsequently confirmed the unknown substance to be 4% cartap hydrochloride.

On examination, the Glasgow Coma Scale (GCS) was 3/15, pulse rate 126/min, blood pressure 120/80 mmHg and respiratory rate 30/min. Pupils were dilated 6mm bilaterally and reacting to light. Deep tendon reflexes were sluggish and Babinski sign was negative. Muscle power could not be assessed because of the low GCS. Rest of systemic examination was unremarkable. He was shifted to the intensive care unit for ventilation and monitoring.

Complete blood count profile and liver and renal function tests were normal. Plasma Butryl-cholinesterase activity was 6595 U/L (Reference range 3000 – 8000 U/L). A loading dose of 150 mg/kg of N-acetylcysteine was given followed by a maintenance dose of 350 mg 8-hourly for 24-hours. He improved over the next 24-hours and was weaned off the ventilator within 36-hours.

There were no residual neurological symptoms or signs. He was discharged on the 5th day. No clinical test was available for diagnosing Cartap poisoning.

Read more here: http://www.japi.org/august_2016/19_cr_cartap.html
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