Robert Garcia1, Amir Karimian1, Chase Donaldson1, Kerry Preston2, Shawna Scully3. 1. a Department of Internal Medicine, William Beaumont Army Medical Center , El Paso , TX , USA. 2. b Department of Clinical Investigation, William Beaumont Army Medical Center , El Paso , TX , USA. 3. c Department of Neurology, William Beaumont Army Medical Center , El Paso , TX , USA.
Abstract
Context: C-4, a commonly used explosive in military operations, is sometimes consumed by soldiers as a rite of passage. The primary component of C-4 is cyclotrimethylenetrinitramine, or Research Department Explosive (RDX), which causes euphoria along with nausea, vomiting, renal injury, encephalopathy and convulsions when consumed in toxic amounts. We present a case of status epilepticus caused by known ingestion of C-4, in which serum levels of the compound were measured with high-performance liquid chromatography (HPLC). Case details: A 22-year-old active-duty male with no prior medical history was brought to the ED with convulsions that only minimally improved traditional anti-epileptic treatment. EEG showed persistent epileptiform activity despite initial management. Continuous propofol infusion, lacosamide and levitiracetam eventually broke the seizures. The patient eventually reported consuming a piece of C-4 four hours prior to the start of his seizure activity. Results: HPLC showed a peak RDX concentration of 3.06 μg/ml. RDX concentration at cessation of seizure activity was 2.43 μg/ml. Conclusion: Per our review of the literature, this is the first case where the explosive's toxicity could directly be measured over time in a human patient. C-4 poisoning must be considered when assessing sudden onset epileptiform activity in soldiers with access to this substance.
Context:C-4, a commonly used explosive in military operations, is sometimes consumed by soldiers as a rite of passage. The primary component of C-4 is cyclotrimethylenetrinitramine, or Research Department Explosive (RDX), which causes euphoria along with nausea, vomiting, renal injury, encephalopathy and convulsions when consumed in toxic amounts. We present a case of status epilepticus caused by known ingestion of C-4, in which serum levels of the compound were measured with high-performance liquid chromatography (HPLC). Case details: A 22-year-old active-duty male with no prior medical history was brought to the ED with convulsions that only minimally improved traditional anti-epileptic treatment. EEG showed persistent epileptiform activity despite initial management. Continuous propofol infusion, lacosamide and levitiracetam eventually broke the seizures. The patient eventually reported consuming a piece of C-4 four hours prior to the start of his seizure activity. Results: HPLC showed a peak RDX concentration of 3.06 μg/ml. RDX concentration at cessation of seizure activity was 2.43 μg/ml. Conclusion: Per our review of the literature, this is the first case where the explosive's toxicity could directly be measured over time in a humanpatient. C-4poisoning must be considered when assessing sudden onset epileptiform activity in soldiers with access to this substance.
Entities:
Keywords:
Anticonvulsant < Pharmaceuticals; CNS and Psychological < Pharmaceuticals; CNS/Psychological < Organ/tissue specific < Complications of poisoning; Other