FOOD POISONING, FATAL - CHINA (NANJING) (03)
A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious
[Thanks to Piero Garzaro MD who also provided this information to
ProMED-mail. - Mod.LM]
From: John W. Aldis <jwaldis at email.msn.com>
I have found several references to the active compound that produced
the poisoning near Nanjing (China). It seems the poisoning was
intentional -- done by a restaurant owner who was jealous of the
success of his cousin's business.
The product that caused the poisonings has been identified as a
popular tetramine rat poison marketed as "Du Shu Qiang," an official
at the Nanjing Military Region General Hospital said. Production of Du
Shu Qiang is banned in China, but the poison is widely used in rural
areas because of its low cost and high effectiveness, the Shanghai
Daily said on Tue 17 Sep 2002. As little as 5 milligrams of the
poison is enough to kill someone, a local doctor told the newspaper.
The active ingredient is "Tetramine; Tetramethylene Disulfotetramine."
A number of Chinese sites (i.e., in Chinese language) refer to the
product, but I cannot find any really good reference on the
English-language sites. It does not appear to be a common ingredient
in rat poison in the West.
Another reference (from an English-language site) noted that tetramine
poisoning produced paralysis similar to that caused by curare, caused
by a toxin in the salivary glands of the red whelk, _Neptunea
antiqua_. However, this is not at all consistent with the symptoms
described in the press releases (coughing up blood, blood coming from
the patients' ears, etc.).
John W. Aldis, M.D.
AAFP, MPH & Tropical Medicine
<jwaldis at email.msn.com>
From: Eric Croddy <ecroddy at miis.edu>
Re: Poisoning in Nanjing, elsewhere in PRC
While other compounds such as fluoroacetates have been implicated in
past poisonings, intentional or otherwise, the recent tragedy in
Nanjing (September 2002) is reported to be Du Shu Qiang (lit: Poison
Rat Strength), tetramethylene disulfotetramine. There are other
Chinese names for it, suggesting its widespread use in the PRC despite
its having been prohibited: Si Er Si (424), San Bu Dao, and Wen Dao
Si. Chinese media report that "unscrupulous" companies continue to
manufacture a number of regulated/restricted pesticides, including
It has a general, oral mammalian toxicity (LD50) of 0.10 mg/kg (from
Chinese Poison Control Center), rat oral LD50 ranging from 0.1 to 0.3
mg/kg. "It has stimulating effects, primarily that produce twitching,
on the central nervous system as well as the heart and liver.
Tetramethylene disulfotetramine has antagonistic effect against
gamma-amino butyrate [GABA], particularly by blocking its receptors.
This effect is reversible. ...Serious cases of poisoning cause rapid
onset of fainting, epileptic-like seizures, full-body twitching,
foaming at the mouth, incontinence, loss of consciousness."
At least one of the case studies provided indicate consistency with
symptoms appearing within 2 hours of poisoning. National Poison
Control Center, CAPM
Other reports have surfaced in Chinese newspapers concerning dogs
having been poisoned by tetramine, then their meat sold on the market
to unsuspecting buyers. (Dushi Kuaibao, 11/16/2001, "Warning: Poisoned
Dog Meat Sent to Market." <http://www.dskb.com.cn/20010825/ca50008.htm>
On 6 Nov 2001, 86 students at a middle school were sent to the
hospital due to what appeared to be Dushuqiang poisoning in Shanxi
province. Authorities later implicated the cook at the cafeteria, who
was reportedly disgruntled and who had adulturated food, including
noodles. See Hangzhou.com.cn website, "Cafeteria Cook Row Leads to 86
Students Being Poisoned," 23 Nov 2001
Senior Research Associate
Monterey Institute of International Studies
Center for Nonproliferation Studies
425 Van Buren St.
Monterey, CA 93940
Eric.Croddy at nsepnet.org
[Many thanks to Dr. Aldis and Eric Croddy for providing additional
information. I too was unable to find much in the English language
literature on the chemical Tetramethylene disulfotetramine. There was
one article found during a PubMed search that suggested that the use
of Vitamin B6 and sodium dimercaptopropane sulfonate immediately in
the post-ingestion period did lead to a reduction in mortality in
rats. (This information is from the abstract as the article was in a
Chinese language journal -- Qiu Z, Lan H, Zhang S, Xia Y, Huang S.
[Antidotal effects of vitamin B(6) and sodium dimercaptopropane
sulfonate on acute poisoning with tetramethylene disulphotetramine in
animals] Zhonghua Nei Ke Za Zhi. 2002 Mar;41(3):186-8. Chinese.) This
thread is now closed. - Mod.MPP]
Gary N. Greenberg, MD MPH Sysop / Moderator Occ-Env-Med-L MailList
gary.greenberg at duke.edu Duke Occupat, Environ, Int & Fam Medicine
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