ProMED: Restaurant poison, China

Gary Greenberg Gary.Greenberg at Duke.edu
Thu Sep 19 21:34:09 EST 2002

A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious 
Diseases <http://www.isid.org>

[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 

- --
Eric Croddy
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
OEM-L Maillist Website:                      http://occhealthnews.net


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