Cartap Hydrochloride Poisoning Causing Respiratory Failure and Seizures

Abstract

Cartap hydrochloride is a commonly used low toxicity insecticide. It is a thiocarbamate with the chemical formula C7H16ClN3O2S2 and a nereistoxin analogue. Major formulations available in India are cartap hydrochloride 4% GR (granules) and cartap hydrochloride 50% SP (soluble powder). We report regarding a 30 year old male patient who presented to the emergency department with alleged history of ingestion of large amount of cartap hydrochloride along with alcohol with intention of suicide. Patient developed hiccups, nausea, vomiting, dyspnea and 2 episodes of generalized tonic clonic seizures. Patient required mechanical ventilation for a period of 5 days and infusion of N-acetyl cysteine.  Toxic effect of Cartap hydrochloride is predominantly through dose-dependent inhibition of  [(3)H]-ryanodine binding to Ca2+ release channel in the sarcoplasmic reticulum and promotion of Ca2+ influx outside the cells and induction of Ca2+ release inside the cells. This is the basis of clinical features of acute poisoning and treatment with British Anti Lewisite and sodium dimercaptopropane sulfonate.