Oral presentation International Symposium on Pesticides June 2

Oral presentation International Symposium on Pesticides, June 2 -6, 1997, Budva, Yugoslavia OUR EXPERIENCE WITH TREATMENT OF ACUTE INTOXICATION BY LANATE B. Pavlovski, N. Popovski, D. Petrovski, L. Meloska Clinic for Toxicology and Urgent Internal Medicine, Clinical Center, Skopje, Macedonia

This group of Pesticides are very toxic agents The basic toxicity is parasympathomimetic-cholinergic effects Resorption: oral Carbamate Pesticides penetrate inhalation-lung skin mucous membrane

BACKGROUND: Organophosphates and Carbamates are assigned to group whose primary target sites of action are Acetylcholine esterase inhibitors. Poisonings by Thiocarbamate and Dithiocarbamate pesticides are very similar to Organophosphate pesticide poisonings as an inhibitors of Acetylcholine esterase(ACh. E) and the other esterases, but at Carbamates, the inhibition of ACh. E is weaker, with shorter duration, and enzyme regenerate is faster than at Organophosphates. As a result of these different chemical reactions, poisonings by Carbamates are with weaker intensity, and always are with better outcomes.

n TOXIC EFFECTS: n Neurodepressive- headache, vertigo, tremor, spasm, myosis, lacrimation, coma n Gastrointestinal- salivant, vomit, nausea, emetic, diarrhea, n Cardiovascular- bradycardia hypertension, hypotension, arrhythmia

INTRODUCTION: We have observed 48 patients acutely intoxicated by Lanate ( 32 women and 16 men). The average of this group was 27± 3 years. Lanate is a protective name in our country for methomyl ( group of Carbamates). All patients were treated in the Intensive care Unit in the period from 1990 to 1994.

The aim of this study was to evaluate exactly therapeutic approach to Lanate poisonings. All patients presented choinergic symptoms similar to poisonings by Organophosphate Insecticides, but with a lesser intensity. All patients had myosis, 9 patients had bradycardia, while others had salivation, lacrimation and muscle fasciculations. Three patients had coma with respiratory failure. Assisted ventilation for 6 to 8 hours was applied in these latter patients. In 34 patients cholinesterase plasma activity from 30 to 50% was observed, in remaining 14 patients was 20%.

The following therapeutic procedure was used: 1. Gastric lavage 2. Cardio-pulmonary and cerebral pharmacological support and control of fluids, electrolytes and acid-base status. 3. Administration of Atropine for supression of cholinergic symptoms priming doses of 35 – 40 mgr. withing the first 24 hours.

Table 1 The data about the patients and antidote treatment __________________________ Men Women 16/32% 32/68%/ Ch. plasma activity 30 -50%/34/71% Reactive Anxiety 20%/14/29% depression reactive depression Antidote Atropine 35 -40 mgr/24 h mean dose 25 mgr/24 h Time of treatment 48 h check-up after 7 days

The patients recovered after a period of 48 hours. At the check up after seven days there were no signs of complications in any of the patients. All patients had psychiatric diagnoses. The poisonings were suicidal. The largest number of male patients intoxicated by Lanate had a reactive depression. Female patients exhibited anxiety depression and reactive depression. In this open control clinical study we had no lethal outcomes.

SUMMARY n n n At the patients acutely intoxicated by Lanate, clinical picture to grow better faster then recovere at the patients acutely intoxicated by Organophosphates Regenerate of Acetylcholinesterase activity is faster than at patients acutely intoxicated by Organophosphates Therapeutic approach: Administration of ampules Atropine until atropinisation ad slowly doses than at Organophosphates poisonings