Acute C4 Ingestion and Toxicity: Presentation and Management

Composition C4 is a plastic explosive substance used in military combat units for demolition. The active component of composition C4 is hexahydro-1,3,5-trinitro-1,3,5-triazine, also known as RDX (Royal Demolition Explosive). There are limited reports of the effects of ingested C4. We sought to provide a broad overview of cyclonite/RDX exposure in humans to give a general understanding of both the clinical effects of exposure as well as management considerations. The authors searched MEDLINE and Google Scholar for articles using the keywords for this literature review, including case reports, case series, animal studies, clinical guidelines, and reviews. There are few reports and studies of C4 ingestion. In these studies, the most common effects are serious central nervous system (CNS) effects followed by renal and gastrointestinal symptoms. Critical actions involve airway control, seizure control, and adequate fluid hydration. The toxidrome of this ingestion is typically transient and management is primarily supportive.