What are the effects and treatment of aldrin poisoning?

Aldrin Poisoning: Effects and Management

Clinical Effects of Aldrin Poisoning

Aldrin is a highly neurotoxic organochlorine insecticide that primarily causes central nervous system toxicity, with seizures being the hallmark manifestation, and can also cause acute cardiac sodium channel blockade leading to life-threatening arrhythmias.

Neurological Effects

• Seizures and convulsions are the most serious and characteristic manifestation of aldrin poisoning, occurring suddenly even without prodromal symptoms 1, 2
• CNS symptoms include headache, dizziness, drowsiness, and altered mental status progressing to coma in severe cases 3, 2
• Epileptiform convulsions can develop after exposure, with associated EEG abnormalities that may persist 1

Gastrointestinal Effects

• Nausea, vomiting, and epigastric pain are common early symptoms, particularly in mild to moderate poisoning 3, 2
• Abdominal discomfort and pain may occur 3

Cardiovascular Effects

• Acute cardiotoxicity occurs through blockade of cardiac sodium channels (Nav1.5), causing ECG abnormalities including prolonged PR, QRS, and QT intervals 4
• Hypertension may develop during acute poisoning 3
• Action potential duration increases with reduced depolarization velocity in cardiomyocytes 4

Other Systemic Effects

• Dyspnea and respiratory distress 3
• Sweating and temperature dysregulation (both hypothermia and hyperthermia reported) 3
• Cold extremities and pallor 3
• Mild jerking movements 3

Severity Classification Based on Serum Levels

Mild Poisoning

• Serum levels < 20 μg/L typically associated with minimal symptoms 2
• Symptoms: nausea, vomiting, epigastric discomfort 2

Moderate Poisoning

• Serum levels 100-200 μg/L indicate moderate intoxication 2
• Symptoms: nausea, vomiting, epigastric pain, headache, dizziness, convulsions 3, 2
• Most patients achieve complete recovery within 24 hours 3

Severe/Fatal Poisoning

• Serum levels > 700 μg/L associated with severe or fatal outcomes 3, 2
• Symptoms: hypothermia or hyperthermia, coma, absence of reflexes, generalized convulsions, severe cardiotoxicity 3

Treatment Approach

Immediate Decontamination

If the patient presents within 3-4 hours of ingestion, administer activated charcoal at 1 g/kg orally in a slurry via nasogastric tube 5

• Gastric lavage may be considered if presentation is very early, though activated charcoal is the primary decontamination method 5

Seizure Management

Administer benzodiazepines as first-line therapy for seizures associated with aldrin poisoning 6

• Benzodiazepines are the standard treatment for toxin-induced seizures and should be given promptly 6
• Seizures can occur suddenly without warning, even in patients who initially appear stable 2

Cardiac Monitoring and Support

• Continuous cardiac monitoring is essential due to aldrin's sodium channel blocking effects causing ECG abnormalities 4
• For life-threatening wide-complex tachycardia, consider sodium bicarbonate administration (similar to other sodium channel blockers) 6
• Standard advanced life support measures for dysrhythmias 6

Supportive Care

• Aggressive fluid resuscitation for gastrointestinal losses 7
• Airway protection and ventilatory support as needed, particularly in patients with altered mental status or seizures 6
• Temperature management for hypo- or hyperthermia 3
• Blood pressure support with vasopressors if needed 6

Monitoring Parameters

• Serial serum aldrin and dieldrin levels correlate with clinical severity and prognosis 3, 2
• Continuous ECG monitoring for cardiac conduction abnormalities 4
• EEG monitoring may reveal abnormalities that persist even after clinical improvement 1

Critical Pitfalls to Avoid

• Do not wait for prodromal symptoms before treating seizures - convulsions can occur suddenly without warning in aldrin poisoning 2
• Do not underestimate mild initial presentations - patients with seemingly minor symptoms can rapidly deteriorate to severe toxicity 3, 2
• Do not delay activated charcoal if patient presents within the appropriate time window, as there is no specific antidote for aldrin 5
• Do not overlook cardiac monitoring - the recently discovered cardiotoxic effects require vigilant ECG surveillance 4

Consultation

Contact your regional poison control center (1-800-222-1222 in the United States) immediately for expert guidance, as aldrin poisoning is uncommon and requires specialized toxicological management 6