Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre.

Journal

Occupational medicine (Oxford, England)
ISSN: 1471-8405
Titre abrégé: Occup Med (Lond)
Pays: England
ID NLM: 9205857

Informations de publication

Date de publication:
08 Nov 2023
Historique:
medline: 10 11 2023
pubmed: 10 11 2023
entrez: 10 11 2023
Statut: aheadofprint

Résumé

Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It's currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide. To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption. We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007-December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed. Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II-III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered. Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC's crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it's still legal.

Sections du résumé

BACKGROUND BACKGROUND
Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It's currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide.
AIMS OBJECTIVE
To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption.
METHODS METHODS
We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007-December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed.
RESULTS RESULTS
Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II-III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered.
CONCLUSIONS CONCLUSIONS
Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC's crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it's still legal.

Identifiants

DOI: 10.1093/occmed/kqad108 PMID: 37948128
pubmed: 37948128
pii: 7389839
doi: 10.1093/occmed/kqad108
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Auteurs

L Bernasconi (L)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy.

M Carnovale (M)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy.

D Lonati (D)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
ORCID: 0000-0001-6285-3445

V M Petrolini (VM)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.

A Schicchi (A)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Experimental Medicine PhD program, University of Pavia, Pavia 27100, Italy.

B Brolli (B)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy.

V M Negrini (VM)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy.

C Grazioli (C)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia 27100, Italy.

O Maystrova (O)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.

E Buscaglia (E)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.

Giulia Scaravaggi (G)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.

F Crema (F)

Department of Internal Medicine and Therapeutics, Section of Pharmacology, University of Pavia, Pavia 27100, Italy.

C A Locatelli (CA)

Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab, Pavia 27100, Italy.

Classifications MeSH