Cartap hydrochloride, a
nereistoxin analog, is a commonly used low toxicity
insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of
Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively. To our knowledge this is the first case report of
Cartap hydrochloride suicidal
poisoning.
Cartap toxicity has been considered to be minimal, but a number of animal models have shown significant neuromuscular toxicity resulting in
respiratory failure. It is hypothesized that the primary effect of
Cartap hydrochloride is through inhibition of the [(3)H]-
ryanodine binding to the Ca(2+) release channel in the sarcoplasmic reticulum in a dose-dependent manner and promotion of extracellular Ca(2+) influx and induction of internal Ca(2+) release. This results in tonic diaphragmatic contraction rather than
paralysis. This is the basis of the clinical presentation of acute
Cartap poisoning as well as the treatment with
chelators namely
British Anti Lewisite and
sodium dimercaptopropane sulfonate.