The fungicide
blasticidin S has been used against a rice blast disease. Reports on its human toxicity are extremely limited, and irritation to GI tract, eye and skin are the presenting symptoms in most afflicted cases. Fatalities resulting from profuse intestinal fluid loss with subsequent
hypotension have also been recorded. In an attempt to delineate the clinical pictures of
blasticidin S poisoning, a retrospective study covering an 8.5-y period was then conducted. A total of 28
blasticidin S poisoning exposures, including 24 suicidal ingestions, were recorded. The ingested amounts in most cases were rather large, while 2 cases were found with estimated dosages up to 10 g. The presented symptoms in most cases were immediate
vomiting,
abdominal pain,
diarrhea and
sore throat which were resolved after
conservative treatment. Nevertheless,
hypotension,
arrhythmia, acrocyanosis, aspiration, and even
coma occurred in severe cases. Fatalities were noted in 5 patients, in whom profound
hypotension and severe aspiration
pneumonitis were the main features.
Poisoning following
blasticidin S ingestion remains a challenge to acute health care physicians. Adequate administration of i.v. fluid and careful monitoring of
electrolytes have been considered as the mainstay in the treatment of
blasticidin S poisoning. Prevention of aspiration and ventilatory support are also crucial for life-saving since
poisoning cases might succumb after massive aspiration.