What is the management for dichlorodiphenyltrichloroethane (DDT) poisoning?

Management of Dichlorodiphenyltrichloroethane (DDT) Poisoning

DDT poisoning should be managed with aggressive supportive care focused on seizure control with benzodiazepines, airway protection, correction of metabolic acidosis, and vigorous fluid resuscitation to prevent acute renal failure.

Immediate Assessment and Stabilization

Airway and Breathing

• Establish and maintain airway patency immediately with bag-mask ventilation or endotracheal intubation for patients with CNS depression, recurrent seizures, or loss of protective airway reflexes 1, 2
• Provide supplemental oxygen and support breathing as required 1
• Early intubation is critical as patients can experience rapid decline in mental status even when initially appearing stable 3

Decontamination

• Perform immediate dermal decontamination by removing all contaminated clothing and washing skin thoroughly with soap and water to prevent continued absorption 1
• Irrigate eyes if ocular exposure occurred 4
• Administer single-dose activated charcoal (1 g/kg) if oral ingestion occurred within 1-2 hours and airway is protected, though this should not be used universally 3

Specific Management of DDT Toxicity

Seizure Control

• Administer benzodiazepines as first-line therapy for seizures and severe agitation, with diazepam preferred or midazolam as alternative 1, 2
• Recurrent convulsions are a hallmark of organochlorine poisoning and require aggressive treatment 2

Cardiovascular Support

• Establish intravenous access immediately 1, 4
• Provide vigorous fluid resuscitation as this is critical to prevent and reverse acute oliguric renal failure, which can develop within 24-48 hours of DDT ingestion 2
• Monitor for hypotension and administer vasopressors (dopamine or vasopressin) if unresponsive to IV fluids 1
• Continuous cardiac monitoring for dysrhythmias is essential 1, 3

Metabolic Complications

• Correct severe metabolic acidosis aggressively as both reported DDT poisoning cases developed this complication 2
• Monitor arterial blood gases and administer sodium bicarbonate if pH falls below 7.20 1
• Check electrolytes, renal function (BUN, creatinine), and liver function tests 3

Renal Protection

• Monitor urine output closely as acute oliguric renal failure can develop by the second day post-ingestion 2
• Perform urinalysis to detect hematuria, which may appear by day 3 2
• Maintain strict fluid balance monitoring and ensure adequate hydration to support renal perfusion 2

Monitoring and Supportive Care

Laboratory Monitoring

• Obtain baseline complete metabolic profile to assess electrolyte imbalances and organ function 3
• Serial monitoring of renal function (BUN, creatinine) every 12-24 hours for first 72 hours 2
• Monitor for development of rhabdomyolysis if prolonged seizures occur 3

Temperature Regulation

• Prevent hypothermia during decontamination, particularly in children, using warmed water and heat lamps as needed 1

Poison Control Consultation

• Contact poison control center (1-800-222-1222 in US) immediately for expert guidance on case-specific management 1

Critical Pitfalls to Avoid

• Do not delay intubation in patients with recurrent seizures or altered mental status, as rapid deterioration can occur 2, 3
• Do not underestimate fluid requirements—inadequate resuscitation contributed to renal failure in reported cases 2
• Do not use gastric lavage routinely; activated charcoal is preferred if gastrointestinal decontamination is indicated 4, 3
• Do not discharge patients early—monitor for at least 24-48 hours as renal complications may develop after initial stabilization 2

Expected Clinical Course

• Most patients with aggressive supportive care recover within 2 weeks without sequelae 2
• Acute renal failure, if it develops, typically reverses by day 10 with appropriate fluid management 2
• Seizures and altered consciousness should improve within days once metabolic derangements are corrected 2

Disposition

• Admit all symptomatic patients to intensive care unit for continuous monitoring and aggressive supportive care 2
• Patients exhibiting any signs of toxicity (seizures, altered mental status, metabolic acidosis) require prolonged monitoring beyond initial stabilization 3
• Asymptomatic patients with confirmed ingestion should be observed for minimum 24 hours given delayed onset of renal complications 2