Carbofuran Poisoning among Farm Workers SALIM SATAR, M.D. 1 , SERDAR SATAR, PH.D. 2 , AHMET SEBE, M.D. 1 , AND HASAN YESILAGAC, M.D. 1 Abstract Accidental or intentional ingestion of carbofuran can produce a life-threatening syndrome that requires prompt diagnosis and treat- ment. This paper investigates unintentional carbofuran poisoning in farm workers. Thirteen patients were admitted to the emergency department with carbofuran poisoning between January 2002 and August 2004 (2 female, 11 male). The patients had been poisoned while mixing the liquid form of carbofuran with seeds. Their hands were red on admission. Complaints most commonly reported by the patients on admission were nausea, vomiting, headache, weakness, dizziness and blurred vision. The most commonly observed signs were tachycardia, tachypnea, salivation, miosis, ele- vated blood pressure, and fasciculation. Three patients were agitated and one was lethargic on admission. We reviewed the patients’ medical charts retrospectively, as well as the demographic data, intoxication route, clinical and laboratory presentations, and outcomes. We made the diagnosis according to a compatible exposure history and clinical findings. The most commonly observed laboratory finding was hyperglycemia, which was found in 6 patients. Serum pseudo- cholinesterase level was low in only one patient. All the patients were cured and discharged from the hospital in good physical condition. Rapid onset, mild illness and quick recovery are typical characteristics of acute occupational carbofuran poisoning. We con- clude that public health efforts should educate farm workers about the dangers of pesticide application so that its threat can be diminished. Key Words: Carbofuran, dermal route, emergency, farm workers, poisoning. Introduction THE CARBAMATES are a group of salts or esters of N- substituted carbamic acid. They are used as agricul- tural and household insecticides. Aldicarb, carbaryl, propoxur, and carbofuran are the ones most com- monly used. Carbamate insecticides differ struc- turally from organophosphorus esters, but both types inhibit acetylcholinesterase. Cholinesterase inhibition caused by carbamate is labile, reversible and of short duration (1). Carbofuran (2,3-dihydro-2,2-dimethyl-7-ben- zofuranylmethylcarbamate) is a carbamate insecti- cide used for the control of soil-dwelling insects in maize, oilseed rape, sorghum, sugar beet, sunflow- ers, vegetables and some fruits. It has two different formulations in the Turkish agricultural market. The first one has 35% active ingredient and is reg- istered to use for seed application in corn and sugar beet. The second one has 5% active ingredi- ent and is restricted for use in foliar application for sugar beet. Carbofuran is one of the metabolites of benfuracarb and was detected in fatal human cases following benfuracarb ingestion (2). Carbofuran inhibits cholinesterase and is metabolized rapidly and completely by hydrolysis in rats; it has been assigned to the Ib toxic class by the World Health Organization (3). Carbofuran was introduced by Bayer AG and is widely used in many countries, including Turkey. Several cases of fatal poisoning by carbofuran following accidental ingestion have been reported (1, 4, 5). We describe 13 cases of unintentional car- bofuran poisoning via the dermal route. Patients and Methods Thirteen adult patients poisoned with carbofu- ran were admitted to Cukurova University’s School of Medicine, Department of Emergency Medicine, between January 2002 and August 2004. Relatives of the patients brought the bottles which contained the liquid carbofuran apparently used. The carbofuran concentration used by our patients was 35%. We made the diagnosis according to a compatible exposure history and clinical findings. © THE MOUNT SINAI JOURNAL OF MEDICINE Vol. 72 No. 6 November 2005 389 From the 1 School of Medicine, Department of Emergency Medi- cine and 2 Faculty of Agriculture, Department of Plant Protection, Cukurova University, Balcali-Adana/Turkey. Address all correspondence to Salim Satar, M.D., Cukurova University, School of Medicine, Department of Emergency Medi- cine, 01330 Balcali-Adana/Turkey; email: ssatar@cu.edu.tr Accepted for publication March 2005.