These are compounds which kill
nematodes (i.e. worms). For example, ethylene dibromide.
are applied to control rodents, nematodes, insects, weed seeds, and fungi
anywhere in the soil, structures, crop, grains, and commodities. Many different
chemical classes have use today. Most fumigants were abandoned because of their
toxicity, many of which were halogenated solvents. The list of discontinued
halogenated hydrocarbons includes carbon tetrachloride, chloroform,
dibromochloropropane, 1,2-dichlo- ropropane, ethylene dibromide, and ethylene
dichloride. Ethylene dibromide was previously approved for use as in citrus,
vegetable, and grain crops, and as a fumigant for turf, particularly on golf
courses. In 1984, the Environment Protection Agency (EPA) banned its use as a soil
and grain umigant. Unfortunately, in India, it continues to be used widely,
causing human poisoning not infrequently.
dibromide alkylates macromolecules causing cellular disruption and reduced
glutathione levels. Cellular disruption in tissues and organs, such as liver
and kidneys, results in progres- sive dysfunction. Manifestation of some of the
effects of acute high exposure may be delayed a few days.
Ethylene dibromide is a severe skin irritant in liquid form,
and inhaling or ingesting it can cause death.
Inhalation/Ingestion: Burning sensation, cough, bronchitis,
dyspnoea, pulmonary oedema, hepatotoxicity with liver necrosis, acute renal
failure, metabolic acidosis, CNS depres-sion, coma and death. Abdominal pain,
vomiting, and diar-rhoea, are common early manifestations in cases of
Dermal Exposure: Erythema, pain, blistering.
Ocular Exposure: Conjunctivitis has been reported after
exposure to ethylene dibromide. Temporary loss of vision may occur.
Chronic Exposure: There is inconclusive but suggestive
evidence that ethylene dibromide may reduce fertility in men. Antispermatogenic
effects have been demonstrated in various animal species.
Serum bromide levels can be used to
document that expo-sure did occur. However, bromide levels do not accurately
predict the clinical course.
Routine laboratory studies include
CBC, glucose, and electrolyte determinations.
Additional studies for patients
exposed to ethylene dibro-mide include liver-function tests and renal-function
In cases of inhalation exposure,
chest radiography and arterial blood gas measurements may be helpful.
Establish a patent airway, ensure adequate respiration and
pulse. Administer supplemental oxygen as required and establish intravenous
access if necessary. Place on a cardiac monitor.
Irrigate exposed skin and eyes as appropriate. Remove
o Flush exposed skin and hair with
water for at least 15 minutes, then wash twice with mild soap. Rinse thor-oughly
with water. Use caution to avoid hypothermia when decontaminating patients,
particularly children or the elderly. Use blankets or warmers after
decontamina-tion as needed.
o Irrigate exposed or irritated eyes
with tap water or saline for 15 to 20 minutes. Remove contact lenses if easily
removable without additional trauma to the eye. An ophthalmic anaesthetic, such
as 0.5% tetracaine, may be necessary to alleviate blepharospasm, and lid
retractors may be required to allow adequate irrigation under the eyelids.
Activated charcoal is helpful in cases of ingestion.
Treat patients who have bronchospasm with an aerosolised
bronchodilator such as salbutamol.
If evidence of shock or hypotension is observed, begin fluid
administration. For adults with systolic pressure less than 80 mmHg, bolus
perfusion of 1,000 ml/hour intravenous saline or lactated Ringer’s solution may
be appropriate. Higher adult systolic pressures may necessitate lower perfusion
rates. For children with compromised perfusion administer 20 ml/kg bolus of
normal saline over 10 to 20 minutes, then infuse at 2 to 3 ml/kg/hour.
There is no proven antidote for ethylene dibromide
poisoning. Dimercaprol (BAL) or N-acetylcysteine have been suggested as
antidotes based on the postulated mechanism of ethylene dibromide’s toxicity.
However, no adequate studies have tested the efficacy of these therapies, and
they are not recommended for routine use.
Supportive and symptomatic measures.
Patients who survive should be monitored over a period of
time for late neuropsychiatric seque\lae.