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Prise en charge d'intoxication aigue par le Chlormequat ingéré massivement

Le groupe "Recherche et expertise toxicologique" de l'AFPREMED a mené des travaux de recherche toxicologique (analytique et clinique) sur le Chlormequat (un pesticide) en collaboration avec les chercheurs de l'université de Shanghai (Chine) et le laboratoire Brucker France. A ce titre, un article rapporte l'application de ces travaux pour la prise en charge diagnostique et thérapeutique d'un cas d'intoxication aigue avec le Chlormequat ingéré massivement. Notons que les auteurs ont parfaitement caractérisé les propriétés toxicologiques et toxicocinétique du Chlomequat , la méthode analytique pour son dosage fiable et précis, et le traitement rationnel de l'intoxication par ce produit.

Mots clés: Keywords: Chlormequat, Suicide, intoxication , Diurèse, Toxicocinétique, LCMS

Case Study: Suicide Attempt by Intentional Ingestion of Chlormequat
Forensic Medicine and Anatomy Research, 2015, 3, 39-42
DOI: 10.4236/fmar.2015.32008
Author(s): Guanghua Yang [1, 2], Djemila Kechkeche [3], Hafid Belhadj-Tahar [2], Alexandre Verdu [4], Nouredine Sadeg [2]
Affiliation(s)
1- School of Medicine, Tongji University, Shanghai, China.
2- AFPreMed, Toxicology Research Group, Toulouse, France.
3- Departement of Chemistry, University of Pierre et Marie-Curie, Paris, France.
4-Bruker France, Marne La Valée, France.

ABSTRACT
Chlormequat is a quaternary ammonium and choline chlorinated derivated is used as plant growth regulating agent. There are very few documented cases of poisoning in humans. We reported a case of non-fatal suicide attempt by chlormequat in France. A 34-year-old woman was admitted to hospital after deliberate consumption of plant growth regulator, C5 SUN, containing chlormequat chloride (460 g/L) and choline chloride (320 g/L). Immediately, she developed symptoms of respiratory distress and a cardiac massage was begun by her father. In this case report, we described the method for an accurate and reliable screening of chlormequat which was based on the combination of Target Analysis powerful software and a high performance TOF-MS (Impact HD from Bruker). After forced diuresis, the kinetic of elimination of chlormequat is biphasic: vascular phase diffusion (half-life of 5.6 hr) followed by a phase of free elimination (half-life of 16.2 h). Although chlormequat poisoning is clinically similar to that observed with anticholinesterase compounds, chlormequat chloride is not an acetylcholinesterase inhibitor. Chlormequat seems to be a weak substrat competitor for cholinesterase leading to acetylcholine accumulation and prolonged depolarization in muscular junction. Cardiac massage, artificial respiration and forced diuresis have significantly improved the prognosis of our patient.

Keywords: Chlormequat, Suicide, Poisoning, Diuresis, Toxicokinetic, LCMS

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