Fatal poisoning by butachlor and chlornitrofen ingested from a bottle marked as nitrofen

Nitrofen has been banned in Taiwan since January 1, 1983 due to its tetroge nicity. A 78 y-o female consumed about 500 ml of herbicide. labeled as nitr ofen, in a suicide attempt. Consciousness disturbance occurred immediately. After 9 h, bloody-tarry stool was noted. Hematemesis occurred 19 h later. Hepatotoxicity and nephrotoxicity also developed. Twitching of head and bot h upper extremities lasting 20-30 sec and up to 5 min developed on day 3. S ometimes an upward gaze with the face turned to the right or a convulsion o f the right upper extremity was observed. EEG showed alpha coma, generalize d slow spike-and-wave complexes, and isolated generalized sharp waves mainl y in the left occipital area. On day 7, endotracheal intubation was perform ed due to apnea: she expired on day 9. The pesticide was found to contain b utachlor and chlornitrofen. The Agricultural Committee prohibited the marke ting of chlornitrofen due to its generation of turners in animals. The comb ination of butachlor and chlornitrofen can result in consciousness disturba nce, leucocytosis, gastrointestinal hemorrhage, rhabdomyolysis, hypocalcemi a, hypoalbuminemia, elevated amylase, nephrotoxicity, hepatotoxicity, seizu res and death. The cytotoxicity of butachlor may be related to the patient' s death. Active components of pesticides should be checked if the clinical course era poisoned patient is unusual to allow appropriate interventions.