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International Journal of Research in Medical Sciences Raj S et al. Int J Res Med Sci. 2014 Feb;2(1):360-361 www.msjonline.org Case Report
Cartap hydrochloride poisoning: a case report
Sumesh Raj*, Sheetal S.
Department of Internal Medicine, Sree Gokulam Medical College, Trivandrum, Kerala, India Received: 4 November 2013
Accepted: 13 November 2013
*Correspondence:
2014 Raj S et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT

Cartap hydrochloride is a thiocarbamate insecticide used for control of chewing and sucking insects of all stages of
development, on many crops. It is an analogue of nereistoxin. Poisoning with cartap is very rarely reported from India. We report a 46 year old man who consumed cartap with alcohol, presented with nausea & vomiting and Keywords: Cartap hydrochloride, Nereistoxin, Insecticide
INTRODUCTION
conjunctival congestion, petechiae over palpebral conjunctiva & subconjunctival hemorrhage of both eyes. Cartap hydrochloride, a nereistoxin analog, is a All other system examinations were normal. The commonly used low toxicity insecticide.1 It is a hemogram, liver function, renal function, coagulation nicotinergic acetyl choline blocker, causes paralysis by profile were normal. The chest X-ray & ECG were blocking cholinergic transmission in central nervous normal. The serum pseudo-cholinesterase level was system of insects.2 Cartap is essentially a contact and stomach poison. Its basic chemical Structure is S, S-[2-(dimethylamino)-1, 3-propanediyl] dicarbamothioate and The patient was managed with supportive measures- is normally used as the hydrochloride (cartap gastric lavage, activated charcoal, pantoprazole He hydrochloride). To the best of our knowledge, there are improved in 24 hours without administering any only two previous case reports of cartap poisoning from antidote. He was discharged on the third day after CASE REPORT
DISCUSSION
A 46 year old male presented to our emergency Cartap was first introduced in Japan in 1967.Cartap has department with history of consumption of cartap been considered to be a relatively safe compound and is hydrochloride, mixed with alcohol. He was a chronic used worldwide. It is a colourless, crystalline solid with ethanolic, diabetic & hypertensive, not on any regular slight odour, with negligible solubility in water, very treatment. He presented with nausea and vomiting. slightly soluble in ethanol. it is an analogue of nereistoxin, a neurotoxic substance isolated from a There was no history of breathlessness, seizure, altered marineannelid.1 It is a nicotinergic acetyl choline blocker, sensorium, excessive salivation, loose stools, sweating. causes paralysis by blocking cholinergic transmission in He was conscious, oriented with stable vitals. His pupils central nervous system of insects. Cartap is essentially a were bilaterally equal, 3 mm size & reacting. He had International Journal of Research in Medical Sciences | January-March 2014 | Vol 2 | Issue 1 Page 360 Raj S et al. Int J Res Med Sci. 2014 Feb;2(1):360-361 Toxicity with cartap is very uncommon. The main routes and dyspnea.1 She improved with N-acetyl cysteine and of exposure are ingestion, skin contact and eye exposure. Cartap and its metabolite, nereistoxin, are thought to act by neuromuscular blockage through inhibition of the To the best of our knowledge this is the first reported postsynaptic nicotinic acetylcholine receptor ion channel, case of Cartap hydrochloride poisoning from India in leading to salivation, nausea, vomiting, abdominal pain, which the patient recovered from poisoning with gastric and tremor of the arms and legs. The ocular manifestations include conjunctival congestion, petechiae & subconjunctival hemorrhage. In severe cases, it causes convulsions, respiratory failure, and subsequent death. At Conflict of interest: None declared present the recommended antidotes for Cartap poisoning are an intravenous injection of 100-200 mg of L-cysteine or an intramuscular injection of 20-60 mg of British Anti REFERENCES
A. S. Praveen Kumar, Deepak Amalnath, T. K. There are only seven reports of human cartap poisoning Dutta Cartap poisoning: A rare case report. Indian J in the literature and are mostly from Japan and China, of which 3 were fatal and 4 survived. Namera et al. reported Boorugu HK, Chrispal A. Cartap hydrochloride an 83-year-old woman with suicidal cartap poisoning by poisoning: A clinical experience. Indian J Crit Care ingestion of 4% cartap, who presented with coma and received gastric lavage 3 hours after ingestion She Namera A, Watanabe T, Yashiki M, Kojima T. recovered completely with the gastric lavage and Simple and sensitive analysis of nereistoxin and its metabolites in human serum using head-space solid-phase micro extraction and gas chromatography- Kiyota et al. reported a case of cartap intoxication: on in a mass spectrometry. J Chormatogr Sci 1999;37:77- woman who ingested solution containing 50% cartap and presented with loss of consciousness to the hospital presumably 45 min after ingestion. She received gastric Sakamoto T, Aruga T et al. Cartap intoxication – lavage immediately after hospitalization and recovered.4 There are only 2 case reports of cartap poisoning from India. Praveen et al. reported a 35-year-old lady with Cite this article as: Raj S, S Sheetal. Cartap
cartap poisoning who presented with nausea, vomiting, hydrochloride poisoning: a case report. Int J Res Med International Journal of Research in Medical Sciences | January-March 2014 | Vol 2 | Issue 1 Page 361

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