Refractory seizures after endosulfan ingestion in a 12-year-old boy

Abstract

We describe the case of a 12 year old boy who presented with acute endosulfan poisoning. On enquiry, the parents gave a history of suicidal consumption of endosulfan. On examination the patient was in status epilepticus, and his general condition was poor. After initial clinical and laboratory assessment the patient was treated with routine management of acute poisoning in the form of gastric lavage where the gastric contents were aspirated initially and the contents were collected for chemical analysis. The lavage was performed with activated charcoal. Since the seizures were non responsive to conventional first line anticonvulsant drugs for 30 minutes, we characterized the case as refractory status epilepticus. In view of the failure of above medication to control the seizures, further management for refractory seizures was initiated, the patient was intubated and put on mechanical ventilation with a loading dose of thiopentone sodium (5 mg/kg). The seizures ceased in 30 minutes. The rate of the infusion was gradually reduced and stopped as flickering movements subsided. After the 5th day the condition of the patient improved and he regained consciousness and was slowly weaned off the ventilator. The patient was discharged on the 10th day from admission in an ambulatory state with no seizures and no neurological deficits.

Conclusion - We suggest the use of other antiepileptic drugs, such as thiopentone sodium, to treat refractory status epilepticus.