Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre

Author:

Bernasconi L12,Carnovale M12,Lonati D1ORCID,Petrolini V M1,Schicchi A13,Brolli B12,Negrini V M12,Grazioli C12,Maystrova O1,Buscaglia E1,Scaravaggi Giulia1,Crema F4,Locatelli C A1

Affiliation:

1. Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia Poison Control Centre, National Toxicology Information Centre, Clinical and Experimental Lab , Pavia 27100 , Italy

2. Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia , Pavia 27100 , Italy

3. Experimental Medicine PhD program, University of Pavia , Pavia 27100 , Italy

4. Department of Internal Medicine and Therapeutics, Section of Pharmacology, University of Pavia , Pavia 27100 , Italy

Abstract

Abstract Background Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It’s currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide. Aims To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption. Methods We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007–December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed. Results Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II–III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered. Conclusions Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC’s crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it’s still legal.

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health

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