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Accidental Ingestion of Vacor Rodenticide: The Symptoms and Sequelae in a 25-Month-Old Child

Accidental Ingestion of Vacor Rodenticide: The Symptoms and Sequelae in a 25-Month-Old Child Abstract • A recently introduced rodenticide containing N-3-pyridylmethyl N′-p-nitrophenyl urea (PNU), Vacor, was accidently ingested by a 25-month-old child, resulting in acute vomiting, lethargy, seizures, and hypoglycemia, as well as chronic evidence of autonomic and peripheral neuropathy and glucose intolerance. Treatment with niacinamide (nicotinamide), may have been of benefit since all problems were resolved within three months of ingestion. This agent (PNU) is remarkably similar chemically and toxicologically to alloxan and streptozocin, both potent beta-cell toxins. These similarities are not only important in regard to the antidote for PNU, but they also suggest that the toxin may cause long-term endocrinologic, neurologic, and oncologic problems. (Am J Dis Child 134:161-164, 1980) References 1. Prosser PR, Karam JH: Diabetes mellitus following rodenticide ingestion in man . JAMA 239:1148-1150, 1978.Crossref 2. Deckert FW, Moss JN, Sambuca AS, et al: Nutritional and drug interactions with Vacor rodenticide in rats, abstracted . Fed Proc 36:990, 1977. 3. Karam JH, Prosser PR, LeWitt PA: Isletcell surface antibodies in a patient with diabetes mellitus after rodenticide ingestion . N Engl J Med 299:1191, 1978. 4. Rodenticide blamed for Korean deaths . Chem Engl News 53:8, 1975. 5. Miller LV, Stokes JD, Silipat C: Diabetes mellitus and autonomic dysfunction after Vacor ingestion . Diabetes Care 1:73-76, 1978.Crossref 6. Stolinsky DC, Sadoff L, Braunwald J, et al: Streptozotocin in the treatment of cancer: Phase II study . Cancer 30:61-67, 1972.Crossref 7. Rerup CC: Drugs producing diabetes through damage of insulin secreting cells . Pharm Rev 22:485-518, 1970. 8. Loftus L, Cuppage FE, Hoogstranten B: Clinical and pathologic effects of streptozotocin . J Lab Clin Med 84:407-413, 1974. 9. Sadoff L: Neprotoxicity of streptozotocin . Cancer Chemother Rep 54:457-459, 1970. 10. Lazarow A, Palay SL: The production and course of alloxan diabetes in the rat . J Lab Clin Med 31:1004-1015, 1946. 11. Arison RN, Ciaccio EI, Glitzer MS, et al: Light and electron microscopy of lesions in rats rendered diabetic with streptozotocin . Diabetes 16:51-56, 1967. 12. Junod A, Lambert AE, Orci L, et al: Studies of the diabetogenic action of streptozotocin . Proc Soc Exp Biol Med 126:201-205, 1967.Crossref 13. Herr RR, Eble TE, Bergy ME, et al: Isolation and characterization of streptozotocin , in Marti-Ibanez F (ed): Antibiotics Annual, Seventh Annual Symposium on Antibiotics . New York, Antibiotic, 1960, pp 236-240. 14. Rakieten N, Gordon BS, Cooney DA, et al: Renal tumorigenic action of streptozotocin (NSC85998) in rats . Cancer Chemother Rep 52:563-567, 1968. 15. Rakieten N, Rakieten ML, Nadkarni MV: Studies on the diabetogenic action of streptozotocin . Cancer Chemother Rep 29:91-98, 1963. 16. Schein PS, Cooney DA, Vernon ML: The use of nicotinamide to modify the toxicity of streptozotocin diabetes without loss of antitumor activity . Cancer Res 27:2324-2332, 1967. 17. Lazarus SS, Shapiro SH: Serial morphologic changes in rabbit pancreatic islet cells after streptozotocin . Lab Invest 27:174-183, 1972. 18. Schein PS, Loftus L: Streptozotocin depression in mouse liver pyridine nucleotides . Cancer Res 28:1501-1506, 1968. 19. Petrack B, Greengard P, Kalinsky H: On the relative efficacy of nicotinamide and nicotinic acid as precursors of nicotinamide adenine dinucleotides . J Biol Chem 241:2367-2372, 1966. 20. Tjalve H, Wilander E: The uptake in the pancreatic islets of nicotinamide, nicotinic acid, and tryptophan and their ability to prevent streptozotocin diabetes in mice . Acta Endocrinol 83:357-364, 1976. 21. Adolphe AB, Glasofer ED, Troefel WM, et al: Fate of streptozotocin (NSC-85998) in patients with advanced cancer . Cancer Chemother Rep ( (pt 1) ) 59:547-556, 1975. 22. Adolphe AB, Glasofer ED, Troefel WM, et al: Preliminary pharmokinetics of streptozotocin, an antineoplastic antibiotic . J Clin Pharmacol 17:379-388, 1977.Crossref 23. Herken H: Antimetabolic action of 6-amino-nicotinamide on the pentose phosphate pathway in the brain , in Aldridge WN (ed): Mechanism of Toxicity . London, Macmillan & Co Ltd, 1971, pp 189-199. 24. Rakieten N, Gordon BS, Beaty A, et al: Modification of renal tumorigenic effect of streptozotocin by nicotinamide: Spontaneous reversibility of streptozotocin diabetes . Proc Soc Exp Biol Med 151:356-361, 1976.Crossref 25. Rakieten N, Gordon BS, Beaty A, et al: Pancreatic islet cell tumors produced by the combined action of streptozotocin and nicotinamide . Proc Soc Exp Biol Med 137:280-283, 1971.Crossref 26. Dixit PK, Bauer GE: Studies on rats with islet B-cell tumors induced by nicotinamide and streptozotocin . Proc Soc Exp Biol Med 152:232-236, 1975.Crossref 27. Chan SJ, Labrecque DA, Hofmann C, et al: Studies of insulin biosynthesis in streptozotocin and radiation induced B-cell tumors from rat pancreas, abstracted . Diabetes 25( (suppl 1) ):343, 1976. 28. Volk BW, Wellman KF, Brancato P: Fine structure of rat islet cell tumors induced by streptozotocin and nicotinamide . Diabetologia 10:37-44, 1973.Crossref 29. Schoental R: Pancreatic islet-cell and other tumors in rats given heliotrine, a monoester pyrrolizidine alkaloid, and nicotinamide . Cancer Res 35:2020-2024, 1975. 30. Christie GS, LePage RN: Liver damage in acute heliotrine poisoning: 1. The intracellular distribution of pyridine nucleotides . Biochem J 84:25-38, 1962. 31. Christie GS, LePage RN: Liver damage in acute heliotrine poisoning: 2. The effect of nicotinamide on pyridine nucleotide concentrations . Biochem J 84:202-212, 1962. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Accidental Ingestion of Vacor Rodenticide: The Symptoms and Sequelae in a 25-Month-Old Child

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Publisher
American Medical Association
Copyright
Copyright © 1980 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1980.02130140035012
Publisher site
See Article on Publisher Site

Abstract

Abstract • A recently introduced rodenticide containing N-3-pyridylmethyl N′-p-nitrophenyl urea (PNU), Vacor, was accidently ingested by a 25-month-old child, resulting in acute vomiting, lethargy, seizures, and hypoglycemia, as well as chronic evidence of autonomic and peripheral neuropathy and glucose intolerance. Treatment with niacinamide (nicotinamide), may have been of benefit since all problems were resolved within three months of ingestion. This agent (PNU) is remarkably similar chemically and toxicologically to alloxan and streptozocin, both potent beta-cell toxins. These similarities are not only important in regard to the antidote for PNU, but they also suggest that the toxin may cause long-term endocrinologic, neurologic, and oncologic problems. (Am J Dis Child 134:161-164, 1980) References 1. Prosser PR, Karam JH: Diabetes mellitus following rodenticide ingestion in man . JAMA 239:1148-1150, 1978.Crossref 2. Deckert FW, Moss JN, Sambuca AS, et al: Nutritional and drug interactions with Vacor rodenticide in rats, abstracted . Fed Proc 36:990, 1977. 3. Karam JH, Prosser PR, LeWitt PA: Isletcell surface antibodies in a patient with diabetes mellitus after rodenticide ingestion . N Engl J Med 299:1191, 1978. 4. Rodenticide blamed for Korean deaths . Chem Engl News 53:8, 1975. 5. Miller LV, Stokes JD, Silipat C: Diabetes mellitus and autonomic dysfunction after Vacor ingestion . Diabetes Care 1:73-76, 1978.Crossref 6. Stolinsky DC, Sadoff L, Braunwald J, et al: Streptozotocin in the treatment of cancer: Phase II study . Cancer 30:61-67, 1972.Crossref 7. Rerup CC: Drugs producing diabetes through damage of insulin secreting cells . Pharm Rev 22:485-518, 1970. 8. Loftus L, Cuppage FE, Hoogstranten B: Clinical and pathologic effects of streptozotocin . J Lab Clin Med 84:407-413, 1974. 9. Sadoff L: Neprotoxicity of streptozotocin . Cancer Chemother Rep 54:457-459, 1970. 10. Lazarow A, Palay SL: The production and course of alloxan diabetes in the rat . J Lab Clin Med 31:1004-1015, 1946. 11. Arison RN, Ciaccio EI, Glitzer MS, et al: Light and electron microscopy of lesions in rats rendered diabetic with streptozotocin . Diabetes 16:51-56, 1967. 12. Junod A, Lambert AE, Orci L, et al: Studies of the diabetogenic action of streptozotocin . Proc Soc Exp Biol Med 126:201-205, 1967.Crossref 13. Herr RR, Eble TE, Bergy ME, et al: Isolation and characterization of streptozotocin , in Marti-Ibanez F (ed): Antibiotics Annual, Seventh Annual Symposium on Antibiotics . New York, Antibiotic, 1960, pp 236-240. 14. Rakieten N, Gordon BS, Cooney DA, et al: Renal tumorigenic action of streptozotocin (NSC85998) in rats . Cancer Chemother Rep 52:563-567, 1968. 15. Rakieten N, Rakieten ML, Nadkarni MV: Studies on the diabetogenic action of streptozotocin . Cancer Chemother Rep 29:91-98, 1963. 16. Schein PS, Cooney DA, Vernon ML: The use of nicotinamide to modify the toxicity of streptozotocin diabetes without loss of antitumor activity . Cancer Res 27:2324-2332, 1967. 17. Lazarus SS, Shapiro SH: Serial morphologic changes in rabbit pancreatic islet cells after streptozotocin . Lab Invest 27:174-183, 1972. 18. Schein PS, Loftus L: Streptozotocin depression in mouse liver pyridine nucleotides . Cancer Res 28:1501-1506, 1968. 19. Petrack B, Greengard P, Kalinsky H: On the relative efficacy of nicotinamide and nicotinic acid as precursors of nicotinamide adenine dinucleotides . J Biol Chem 241:2367-2372, 1966. 20. Tjalve H, Wilander E: The uptake in the pancreatic islets of nicotinamide, nicotinic acid, and tryptophan and their ability to prevent streptozotocin diabetes in mice . Acta Endocrinol 83:357-364, 1976. 21. Adolphe AB, Glasofer ED, Troefel WM, et al: Fate of streptozotocin (NSC-85998) in patients with advanced cancer . Cancer Chemother Rep ( (pt 1) ) 59:547-556, 1975. 22. Adolphe AB, Glasofer ED, Troefel WM, et al: Preliminary pharmokinetics of streptozotocin, an antineoplastic antibiotic . J Clin Pharmacol 17:379-388, 1977.Crossref 23. Herken H: Antimetabolic action of 6-amino-nicotinamide on the pentose phosphate pathway in the brain , in Aldridge WN (ed): Mechanism of Toxicity . London, Macmillan & Co Ltd, 1971, pp 189-199. 24. Rakieten N, Gordon BS, Beaty A, et al: Modification of renal tumorigenic effect of streptozotocin by nicotinamide: Spontaneous reversibility of streptozotocin diabetes . Proc Soc Exp Biol Med 151:356-361, 1976.Crossref 25. Rakieten N, Gordon BS, Beaty A, et al: Pancreatic islet cell tumors produced by the combined action of streptozotocin and nicotinamide . Proc Soc Exp Biol Med 137:280-283, 1971.Crossref 26. Dixit PK, Bauer GE: Studies on rats with islet B-cell tumors induced by nicotinamide and streptozotocin . Proc Soc Exp Biol Med 152:232-236, 1975.Crossref 27. Chan SJ, Labrecque DA, Hofmann C, et al: Studies of insulin biosynthesis in streptozotocin and radiation induced B-cell tumors from rat pancreas, abstracted . Diabetes 25( (suppl 1) ):343, 1976. 28. Volk BW, Wellman KF, Brancato P: Fine structure of rat islet cell tumors induced by streptozotocin and nicotinamide . Diabetologia 10:37-44, 1973.Crossref 29. Schoental R: Pancreatic islet-cell and other tumors in rats given heliotrine, a monoester pyrrolizidine alkaloid, and nicotinamide . Cancer Res 35:2020-2024, 1975. 30. Christie GS, LePage RN: Liver damage in acute heliotrine poisoning: 1. The intracellular distribution of pyridine nucleotides . Biochem J 84:25-38, 1962. 31. Christie GS, LePage RN: Liver damage in acute heliotrine poisoning: 2. The effect of nicotinamide on pyridine nucleotide concentrations . Biochem J 84:202-212, 1962.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1980

References