Charcoal accidental exposure

Similarly, convulsive seizures and a sustained epileptic state persisted after stomach contents were pumped and activated charcoal and anticonvulsive medication were administered in a 43-year-old man who ingested approximately 260 mg/kg endosulfan (Boereboom et al. 1998). At 4 days after exposure, the man was pronounced brain dead, and autopsy revealed cerebral hernia from massive cerebral edema. Eight additional accidental and/or intentional cases of acute poisoning with endosulfan resulting in adverse neurological effects have been reported in more recent studies, six by Blanco-Coronado et al. (1992), one by Lo et al. (1995), and one by Pradhan et al. (1997) two out of the eight resulted in death. Tonic-clonic convulsions were seen in the Blanco-Coronado et al. (1992) cases, whereas Lo et al. (1995) reported the development of muscle fasciculations and episodes of convulsions in their case. In the case reported by Pradhan et al. (1997), the patient had consumed about 75 mL of hquid endosulfan (35% w/v). In this case, in addition to tonic-clonic seizures and myoclonic jerks, the patient developed... 

The basis of clinical management is supportive care. The airway should be secured and protected as needed. Symptomatic patients should have intravenous access and cardiac monitoring. Accidental ingestions exceeding 500-800 mg, and all intentional overdoses, should be treated with oral activated charcoal if patients present within 60 min of exposure. Seizures should be treated with benzodiazepines, or phenobarbital if refractory. Hypotension should be treated with intravenous fluids and vasopressors (dopamine or norepinephrine) if needed. Hemodialysis or hemoper-fusion may enhance elimination of both the parent compound and metabolites, but the clinical value of... 

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