School of Medicine Department of Internal Medicine

DEPARTMENT OF INTERNAL MEDICINE

* Several persons at a plant in Waynesboro ingested about 60 mg of a substance they thought was "Spanish fly" on November 17, 1978.

* Two were admitted to UVa Hospital, one suffered seizures and a respiratory arrest.

* The substance actually ingested was 4-aminopyridine (AVITROL), a bird poison. It is extremely poisonous, and has NO aphrodisiac properties.

* This material is coarse, crystalline (like table salt) and tan in color. It is very dangerous and should be avoided.

* PLEASE REFER ANY INFORMATION OR QUESTIONS CONCERNING THIS SUBSTANCE TO THE POISON CONTROL CENTER AT UVA HOSPITAL. CALL COLLECT: (804) 924-5543.
 
 

 Partial report from University of Virginia, school of Medicine, Department of Internal Medicine, Charlottesville, Virginia, 22908.

SUPPORT VITAL FUNCTION

1) Establish respiration and assure an airway. Cardiopulmonary resuscitation as required.

PREVENTION OF ABSORPTION

2) Emesis should be initiated unless the patient is unable to protect his airway (coma, convulsing, no gag reflex).

3) If emesis is contraindicated then gastric lavage with a large bore tube should be preceded with endotrachial intubation.

4) Activated charcoal, 10 times the ingested dose or 1 gram/kg, in a water slurry, by mouth or NG tube.

5) Sodium sulfate cathartic, 0.25g/kg, in a 10% solution, by mouth or NG tube. May be mixed with the charcoal.

SPECIFIC MEASURES

6) Pancuronium is a pharmacologic antagonist and should be considered in the severely poisoned patient. The patient should be intubated and closely monitored.

7) There is evidence that propranalol may block some of the cardiac toxicity of 4-AP and it should be considered in treatment of serious arrhythmias.

8) Seizures may be treated with IV diazepam, 0.1mg/kg, max. 10 mg per dose, maximum 60mg.
Avitrol may be acquired compounded with as bird bait. It is also readily available in reagent grade from chemical suppliers. The 10gm which the patient obtained is about 200 times the lethal dose.
Note: The lethal dose is 1/20 of 1 gram or approx. 1/600th of a teaspoon. - Ed.
 
 

AVAILABLE FORMS

Four aminopyridine (4-AP) is an acutely toxic pesticide developed by Phillips Petroleum Company and marketed in 1963 as an avicide under the name "Avitrol". The manufacturer considers this a bird "repellent".

It is marketed as a poison bait containing corn, wheat, sorghum, or peanut butter with 0.03% to 1% 4-AP. It is available as concentrate of 25% or 50% 4-AP cut with powdered sugar.

CLINICAL EFFECTS

Doses near the LD 50 in mammals produce a usual sequence of symptoms: hyperexcitability, salivation, tremors, muscle incoordination, convulsions, and cardiac or respiratory arrest. Initial symptoms occur within 10 to 15 minutes progressing rapidly to death in 15 minutes to 4 hours.

Two adult males ingested about 60mg (0.6mg/kg) 4-AP dissolved in about 180 ml of water. Both reported almost immediate abdominal discomfort, developed nausea and vomiting, weakness, dizziness, and intense diaphoresis over the next 5 - 15 minutes. Both patients were found to have a metabolic acidosis, one suffered a severe tonic-clonic seizure and respiratory arrest.

RANGE OF TOXICITY

The acute toxicity of 4-AP has been studied in several bird and mammal species [9]: