cartap is a pesticide first introduced in japan in 1967 and commonly used to control weevil and caterpillars . its basic chemical structure is s , s-[2-(dimethylamino)-1,3-propanediyl ] dicarbamothioate and is normally used as the hydrochloride ( cartap hydrochloride ) . there are only a few reports of cartap poisoning in humans in the literature[26 ] and no reports from india . we report a case of cartap poisoning in a 35-year - old female who presented with vomiting , abdominal pain and dyspnea . a 35-year - old lady presented to our casualty with history of suicidal consumption of handful of cartap powder mixed in water ( 50% cartap ) . at presentation also , there was no history of increased salivation , diarrhea , chest pain or palpitations . her pulse rate was 96/min , blood pressure 120/80 mmhg , and respiratory rate was 26/min , and there was no respiratory paradox or neck flop . the arterial blood gas analysis showed respiratory alkalosis ( ph 7.50 ) with saturation of 98% ( spo2 ) , partial pressure of oxygen 74 mmhg ( pao2 ) , paco2 40 mmhg and bicarbonate of 24 meq / l . the patient was managed initially with gastric lavage with water , and in view of tachypnea and breathlessness , she was treated with intravenous n - acetyl cysteine at a total dose of 15 g over 24 hours . her symptoms completely resolved after 2 days of symptomatic management and she was observed in the hospital for a week before discharge . it is obtained as a granular powder material with the brand name padan in japan and various brand names in india . the use of cartap in india began in 1988 after an agreement with japan from where the technical grade product ( cartap ) is imported . two formulations are made in india from this technical grade product : 4% granule form and 50% water - soluble powder form . the 4% granule form is used for controlling paddy and sugarcane pests and 50% powder form for control of diamond black moth in cabbage and cauliflower . the world health organization ( who , 1978 ) has classified cartap hydrochloride as a  moderately hazardous technical product  ( toxicity class ii ) . cartap and its metabolite , nereistoxin , are thought to act by neuromuscular blockage through inhibition of the postsynaptic nicotinic acetylcholine receptor ion channel , leading to salivation , nausea , vomiting , abdominal pain , and tremor of the arms and legs . in severe cases the main cause of death in cartap poisoning is respiratory failure due to neuromuscular blockage . there are reports of death due to multiorgan failure and disseminated intravascular coagulation ( dic ) . a study by liao et al . in rabbits showed that respiratory failure following ocular exposure of cartap was mainly due to calcium - mediated diaphragmatic contracture rather than neuromuscular blockage . it was thought that similar kind of mechanisms could be involved in the development of respiratory failure in humans . there are only five reports of human cartap poisoning in the literature and are mostly from japan and china . among them , three reports are of fatal toxicity and the patients succumbed to poisoning , and the other two reports are of low toxicity and the patients recovered completely with treatment . reported an 83-year - old woman with suicidal cartap poisoning by ingestion of padan containing 4% cartap , who presented with coma and received gastric lavage 3 hours after ingestion . reported a case of cartap intoxication in a woman who ingested padan solution containing 50% cartap and presented with loss of consciousness to the hospital presumably 45 min after ingestion . these are the only two reports out of five case reports in the literature in which the patients recovered from poisoning with gastric lavage and supportive management . reported a fatal case of cartap intoxication in a 50-year - old female who ingested padan containing 75% cartap . she received treatment only with gastric lavage and died due to multiple organ failure and dic on the 6th day of hospital admission . in a recent report by kurisaki et al . , a 35-year - old man with 13 g of padan ( 75% cartap ) poisoning presented with hypoxemia and decreased level of consciousness . at hospital , he developed multiorgan failure , dic and expired on day 5 of poisoning . it is clear from the above reports that none of them have used n - acetyl cysteine in the management of cartap poisoning , and presently there are no recommendations for its use in humans . acute accidental / suicidal ingestion of cartap is managed by stomach wash with water and by administering cysteine as an antidote ( universal crop protection data sheet , 2007 ) . several sulfhydryl - containing compounds ( l - cysteine , d - penicillamine ) in experimental animals have delayed the onset of symptoms from cartap hydrochloride poisoning . there are no case reports or studies regarding the use and effectiveness of n - acetyl cysteine in humans with cartap poisoning . in the case report by kiyota et al . , gastric lavage is recommended as an effective treatment for cartap poisoning . reported a case that did not improve following gastric lavage within 45 min of cartap poisoning and the patient died of multiorgan failure and dic . our patient presented within 8 hours of cartap poisoning with nausea , vomiting , abdominal pain and dyspnea . she was initially managed with stomach wash and intravenous fluids . in view of dyspnea , increased respiratory rate and reports of fatal toxicity and as gastric lavage alone is controversial in the management of poisoning , our patient received treatment with intravenous n - acetyl cysteine ( 15 g ) though there are no clear recommendations for its use in human cartap poisoning . her symptoms completely resolved over 2 days and she was monitored in the hospital for respiratory muscle weakness . her stay in the hospital was uneventful and she was discharged from the hospital after a week . in conclusion , cartap poisoning is very rare and usually causes low toxicity though fatal toxicity can occur . the role and effectiveness of n - acetyl cysteine in cartap poisoning is yet to be clarified in humans and more case studies may aid in this regard .
cartap is a pesticide commonly used to control weevil and caterpillars . 
 it is an analogue of nereistoxin , a neurotoxic substance isolated from the marine annelid lumbriconereis heteropoda . 
 it causes neuromuscular blockade . 
 poisoning with cartap is very rare and not yet reported from india . 
 we report a 35-year - old lady with cartap poisoning who presented with nausea , vomiting , and dyspnea . 
 she improved with n - acetyl cysteine and symptomatic management .