Abstract  Composition C-4 (C-4) is a plastic explosive widely used in both military and civilian settings. Ingestion of the active ingredient, RDX (cyclonite), can cause generalized seizures. Accidental and intentional C-4 (RDX) intoxications have occurred during manufacture or in wartime. In the literature the intentional ingestion of C-4 has been reported but not verified. We present a case of intentional C-4 abuse.

Abstract  C-4 is a plastic explosive substance similar in structure to Semtex that is used by both military and terrorist organizations. It has a reputation for producing a buzz as well as a bang.

Abstract  Cyclotrimethylenetrinitramine (RDX) is a highly explosive compound frequently used for both military and civilian purposes. Previously reported cases of human RDX intoxication were limited to wartime settings and have described no human pharmacokinetic data. We report the first human intoxication to occur in a non-wartime setting. This intoxication presented with status epilepticus in a child and permitted the description of RDX human pharmacokinetics. It also suggested a strong association between central nervous system dysfunction and RDX intoxication.

Abstract  Composition C-4 is the most common plastic explosive employed by the military in Vietnam. Ingestion is followed in a few hours by multiple generalized seizures, hematuria, severe nausea and vomiting, muscle twitching, and mentation changes. Six patients requiring hospitalization were treated by gastric lavage, maintenance of airway, control of seizures, monitoring of urine volume, and maintenance of fluid and electrolyte balance. No fatalities were observed.

Abstract  INTRODUCTION: C-4 is a plastic explosive widely used for demolition in both military and civilian settings. Severe toxicity following unintentional oral exposures or abuse have been reported in single case reports and small case series. CASE SERIES: Seventeen previously healthy male Army commandos admitted to a secondary referral hospital in Sri Lanka following oral C-4 poisoning. METHODS: This data was collected as part of a prospective cohort study recruiting all patients admitted to general hospitals in Sri Lanka with a history of poisoning. History, clinical, and laboratory outcomes were recorded until discharge. RESULTS: All 17 patients survived. The prominent clinical features were seizures, headache, nausea, and vomiting. Hypokalaemia and elevation of creatine kinase, lactate dehydrogenase, and phosphate were noted in all but two patients. Metabolic acidosis occurred in two patients following seizures and this resolved spontaneously. CONCLUSIONS: Management recommendations include standard resuscitation, supportive care, and benzodiazepines for the control of seizures or agitation. Poisoning with C-4 is an unusual cause of seizures which should be considered in patients with access to this agent.

Abstract  The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.

Abstract  The accidental or intentional ingestion of toxic substances frequently results in life threatening complications of various types. Frequently, the nature of the offending substance is unknown to the physician who must care for the critically ill or potentially critically ill patient. The following case reports describe two patients who, while intoxicated with ethanol, ingested unknown quantities of Composition C-4, a plastic-type explosive. This substance is widely available in Vietnam. Since there have been no previous reports in the literature of ingestion of this substance, the two cases are reported in some detail. Comments are made about the composition and chemical structure of C-4 together with a brief discussion of known toxic effects of some of its breakdown products.

Abstract  The cardinal signs of menigococcal septicaemia, a potentially lethal condition, is a widespread petechial rash, the development of which is a strong indication for immediate parenteral benzylpenicillin. Diagnostic confusion can occur, however. Reported here is a case of generalized petechial rash thought initially to be meningococcal in origin but ultimately found to be the result of a grand mal seizure induced by the ingestion of 'RDX', a plastic explosive constituent.

Abstract  Composition C-4 is a putty-like explosive material that is widely used in Vietnam by US forces. It is found in Claymore mines and in standard demolition kits. Detonation is usually accomplished with a blasting cap. The main chemical component of Composition C-4 is RDX, which has been used as an explosive since World War I. The chemical structure of RDX is cyclotrimethylenetrinitramine, which is similar to TNT. Although insoluble in water, in 80 per cent ethanol RDX is broken down to its constitutent parts of methylamine, nitrous acid, ammonia, and formaldehyde. Composition C-4 also contains small amounts of polyisobutylene, motor oil and sebacate.

Abstract  Data concerning the toxicological effects of cyclotrimethylenetrinitramine (RDX) are limited; only two reports of RDX toxicity to humans have appeared in the European medical literature. This report will present a review of the literature regarding toxicological data and occupational human exposure and a descriptoin of the medical and industrial hygiene aspects of five cases of illness from RDX exposure.

Abstract  Trimethylenetrinitroamine or <> or <> is an explosive obtained by treating urotropine with nitric acid. Workmen employed in the last phases of the production of this explosive, and especially in the drying and sieving, are exposed to the inhalation of powdered material. Several of them have shown a symptomatology consisting in generalised epileptic fits accompanied by loss of consciousness, absence of reflexes, biting of the tongue, salivation, enuresis and involuntary discharge of semen. The fits started suddenly, sometimes preceded by periods of sleelessness and nervous irritability; they were followed by deep coma lasting for several hours and often ending in vomiting and subsequent amnesia.Out of some 20 workmen exposed to the dust of T4, 17 had convulsive fits or attacks of loss of consciousness, either isolated or repeated. This fact cannot, therefore, be considered as casual but seems to be connected with the inhalation of T4 powder. The workmen mainly affected by fits were those given to excessive drinking and eating, but there have been cases of persons so affected who were absolutely free from disease or vice. The authors believe that the epileptic fits are due to cortical angiospastic crises caused by absorption of T4.

Abstract  Two cases of hexogen-induced seizures after occupational exposure in a French explosive factory are described. The workers were hand-sieving large amounts of dry hexogen powder, for 4 and 6 hours respectively. Recurrent seizures occurred despite anticonvulsant therapy, 6 and 2 hours after admission, respectively. E.E.G., C.T. scan and M.R.I. were normal in the first patient as was E.E.G. in the second; both recovered uneventfully. Previous cases were found after a retrospective study of the factory's medical records. The available toxicological data on this rare occupational poisoning are reviewed.

Abstract  Background: Hexogen (cyclonite, RDX) nitrate explosive is an infrequent cause of poisoning. Case Report: A 42-year-old man with no prior history of epilepsy experienced grand mal seizures after sieving fine hexogen (RDX) powder for four hours in an ammunition plant. Physical examination was normal on arrival at the emergency room but recurrent seizures occurred six hour after admission. EEG, CT scan and MRI were normal and the patient recovered uneventfully. Conclusions: The available toxicological data on this rare occupational poisoning are reviewed.

Abstract  Composition C-4 is a soft putty-like "plastic" explosive that is widely used throughout the Republic of South Vietnam by the U.S. Armed Forces. This explosive is found in Claymore land mines and in standard demolition kits. A blasting cap is required to accomplish detonation. Composition C-4 burns easily and gives off intense heat without exploding and, therefore, is frequently used by soliders in the field or in base camps to heat food. It is often carelessly used for this purpose, resulting in accidental ingestion or prolonged exposure to its fumes while it burns.