Incidence et caractéristiques des intoxications graves au méthomyl (carbamate anticholinestérasique) à l'île de la Réunion

Abstract

Objective: To define the incidence and characteristics of acute poisoning by methomyl (Lannate 20 L® ingestion.

Design: Retrospective epidemiologic study based on medical records from the Hospital Sud Reunion on Reunion Island between June 1991 and March 1995.

Recruitment of cases: Any patient poisoned by ingestion of Lannate 20 L®.

Results: Fifty-six poisonings were listed, among which 42 males aged 40 ± 13.2 years old and 14 females aged 31 ± 12.5 years old. The ingested dose was estimated at 50 ml Lannate 20 L for six patients (142.8 mg/kg), and was unknown for the others. Twelve patients deceased before hospital admission. Among the 44 other victims, 25% presented a muscarinic syndrome, 27% a ganglionic nicotinic syndrome, 70% a CNS syndrome (coma) and 77.3% a respiratory distress syndrome. Thirty-six patients (82%) had a blood level of pseudocholinesterases below 2,000 UI/L. Thirty-five patients required immediate intubation and ventilation. The mean atropine dose required by 42 patients was 38.5 + 42.6 mg over the first 24 ± 33 hours. Nine patients died in the intensive care unit.

Conclusions: Poisoning by methomyl has to be treated in intensive care units. Atropine remains the first-line treatment and oximes are not yet systematically used in this indication.