1. Oral presentation International Symposium on Pesticides, June 2-6, 1997, Budva, Yugoslavia OUR EXPERIENCE WITH TREATMENT OF ACUTE INTOXICATION BY LANATE B. Pavlovski, N. Popovski, D. Petrovski, L. Meloska Clinic for Toxicology and Urgent Internal Medicine, Clinical Center, Skopje, Macedonia

2. This group of Pesticides are very toxic agents The basic toxicity is parasympathomimetic-cholinergic effects Resorption: oral Carbamate Pesticides penetrate inhalation-lung skin skin mucous membrane mucous membrane

3. BACKGROUND: Organophosphates and Carbamates are assigned to group whose primary target sites of action are Acetylcholine esterase inhibitors. Poisonings by Thiocarbamate and Dithiocarbamate pesticides are very similar to Organophosphate pesticide poisonings as an inhibitors of Acetylcholine esterase(AChE) and the other esterases, but at Carbamates, the inhibition of AChE is weaker, with shorter duration, and enzyme regenerate is faster than at Organophosphates. As a result of these different chemical reactions, poisonings by Carbamates are with weaker intensity, and always are with better outcomes.

4. TOXIC EFFECTS: TOXIC EFFECTS: Neurodepressive- headache, vertigo,tremor, spasm,myosis,lacrimation, coma Neurodepressive- headache, vertigo,tremor, spasm,myosis,lacrimation, coma Gastrointestinal- salivant,vomit,nausea,emetic,diarrhea, Gastrointestinal- salivant,vomit,nausea,emetic,diarrhea, Cardiovascular- bradycardia hypertension, hypotension, arrhythmia Cardiovascular- bradycardia hypertension, hypotension, arrhythmia

5. INTRODUCTION: INTRODUCTION: We have observed 48 patients acutely intoxicated by Lanate ( 32 women and 16 men).The average age of this group was 27± 3 years. Lanate is a protective name in our country for methomyl ( group of Carbamates). All patients were treated in the Intensive care Unit in the period from 1990 to 1994. We have observed 48 patients acutely intoxicated by Lanate ( 32 women and 16 men).The average age of this group was 27± 3 years. Lanate is a protective name in our country for methomyl ( group of Carbamates). All patients were treated in the Intensive care Unit in the period from 1990 to 1994.

6. The aim of this study was to evaluate exactly the therapeutic approach to Lanate poisonings. All patients presented choinergic symptoms similar to poisonings by Organophosphate Insecticides, but with a lesser intensity. The aim of this study was to evaluate exactly the therapeutic approach to Lanate poisonings. All patients presented choinergic symptoms similar to poisonings by Organophosphate Insecticides, but with a lesser intensity. All patients had myosis, 9 patients had bradycardia, while others had salivation, lacrimation and muscle fasciculations.Three patients had coma with respiratory failure. Assisted ventilation for 6 to 8 hours was applied in these latter patients. All patients had myosis, 9 patients had bradycardia, while others had salivation, lacrimation and muscle fasciculations.Three patients had coma with respiratory failure. Assisted ventilation for 6 to 8 hours was applied in these latter patients. In 34 patients cholinesterase plasma activity from 30 to 50% was observed, in remaining 14 patients was 20%. In 34 patients cholinesterase plasma activity from 30 to 50% was observed, in remaining 14 patients was 20%.

7. The following therapeutic procedure was used: 1. Gastric lavage 2. Cardio-pulmonary and cerebral pharmacological support and control of fluids, electrolytes and acid-base status. 3. Administration of Atropine for supression of cholinergic symptoms priming doses of 35 – 40 mgr. withing the first 24 hours.

8. Table 1 The data about the patients and antidote treatment ____________________________________________________ Men Women Ch.plasma Antidote Time of activity Atropine treatment activity Atropine treatment 16/32% 32/68%/ 30-50%/34/71% 35-40mgr/24h 48h Reactive Anxiety 20%/14/29% mean dose check-up depression depression 25mgr/24h after 7 days reactive reactive depression depression

9. The patients recovered after a period of 48 hours. At the check up after seven days there were no signs of complications in any of the patients. All patients had psychiatric diagnoses.The poisonings were suicidal.The largest number of male patients intoxicated by Lanate had a reactive depression. Female patients exhibited anxiety depression and reactive depression. In this open control clinical study we had no lethal outcomes.

10. SUMMARY At the patients acutely intoxicated by Lanate, clinical picture to grow better faster then recovere at the patients acutely intoxicated by Organophosphates At the patients acutely intoxicated by Lanate, clinical picture to grow better faster then recovere at the patients acutely intoxicated by Organophosphates Regenerate of Acetylcholinesterase activity is faster than at patients acutely intoxicated by Organophosphates Regenerate of Acetylcholinesterase activity is faster than at patients acutely intoxicated by Organophosphates Therapeutic approach: Administration of ampules Atropine until atropinisation ad slowly doses than at Organophosphates poisonings Therapeutic approach: Administration of ampules Atropine until atropinisation ad slowly doses than at Organophosphates poisonings