Tetramethylenedisulfotetramine: Old agent and new terror

Tetramethylenedisulfotetramine has accounted for numerous intentional an unintentional posionings in China. In may 2002, thefirst known case of human illness in the united states caused by tetramethylenedisulotetramine, a banned neurotoxic rodenticide from China, occured in New York City. The clinical presentation after tetramethylenedisulfotetramine exposure is dose dependent, and the most recognized complication is status epilepticus. Posionings may be fatal within hours. No known antidote exists, and treatment mainly is supportive. Anecdotal reports, case reports, and 2 animal studies suggest possible success with certain pharmacological interventions, including pyridoxine and chelation therapy. Pesticide and rodenticide posonings, whether intentional or unintentional, pose a serious threat to populations, and the availability of a banned rodenticide such as tetramethylenedisulfotramine, with its associated morbidity and lethality, is a serious public health concern. Given the recent case report that confirms the presence of tetramethylenedisulfotramine in the United States, the toxicity of the compound, its unique physical properties, the absence of an antidote, and the history of its use as an agent of intentional mass poisoning, public health entities have undertaken educational efforts to inform the public, health care providers, and emergency personnel of this potentially lethal rodentricide.