Illegally imported foreign products can result in domestic exposures to unusual toxic chemicals, and health-care providers might not be able to provide appropriate therapy because the chemical ingredients might not be listed or recognized even after translation of the product label. This report describes the first known case in the United States of exposure to a Chinese rodenticide containing the toxin tetramethylenedisulfotetramine (TETS), a convulsant poison. The report of this investigation highlights the need to prevent such poisonings through increased public education, awareness, and enforcement of laws banning the importation of illegal toxic chemicals.
On May 15, 2002, a previously healthy female infant aged 15 months living with her family in New York City was found by her parents to be playing with a white rodenticide powder that they had brought from China and applied in the corner of their kitchen. After 15 minutes, the child had generalized seizures and was taken to an emergency department. Her initial blood glucose level was 108 mg/dL (normal range: 80-120 mg/dL). Despite aggressive therapy with lorazepam, phenobarbital, and pyridoxine, she had intermittent generalized seizure activity for 4 hours and required intubation.
After 3 days, the infant was extubated successfully but appeared to have multiple neurologic deficits, including absence seizures and possibly cortical blindness. Continuous electroencephalogram monitoring, performed during the initial hospitalization, revealed multiple epileptogenic foci. The infant was discharged in June; as of November 5, the infant remained severely developmentally delayed and was on valproic acid therapy for seizure control.
Translation of the rodenticide package labeling from Chinese to English did not clarify its contents (Figure). A search of the China National Poison Control Center's (NPCC) web-site for rodenticides suggested that the ingredients might have included sodium monofluoroacetate, fluoroacetamide, tetramethylenedinitrosotetramine, or strychnine. However, an initial laboratory analysis was negative for sodium fluoroacetate, fluoroacetamide, bromethalin, strychnine, 1,3-difluoro, 2-propanol, and carbamate insecticides.
On September 14, a snack shop owner in China poisoned food in a competitor's snack shop with a rodenticide identified as Dushuqiang, resulting in 38 deaths. Although Dushuqiang, which contains TETS, has been banned for sale since the mid-1980s, it is still widely available in China. Following news reports of this incident, the New York City Poison Control Center conducted additional laboratory testing of the product associated with the poisoning in New York City and confirmed TETS in the product by gas chromatography-mass spectrometry (GC-MS). TETS concentration was 6.4% weight/weight [w/w] in one rodenticide packet and 13.8% w/w in another.
Reported by: F Barrueto Jr, MD, LS Nelson, MD, RS Hoffman, MD, New York City Poison Control Center; MB Heller, PhD, Public Health Laboratory, General Toxicology and Environmental Science Laboratory, New York City Dept of Health and Mental Hygiene; PM Furdyna, New York State Div of Environmental Conservation; RJ Hoffman, MD, Div of Toxicology, Maimonides Medical Center, New York, New York. KS Whitlow, DO, MG Belson, MD, AK Henderson, PhD, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.
Morbidity and Mortality Weekly Report. 2003;52(10) © 2003 Centers for Disease Control and Prevention (CDC)
Cite this: Poisoning by an Illegally Imported Chinese Rodenticide Containing Tetramethylenedisulfotetramine - New York City, 2002 - Medscape - Mar 14, 2003.