Introduction: C4 is a plastic explosive commonly used in military applications, and is predominantly composed of cyclonite or RDX (Royal Demolition Explosive). C4 toxicity is a documented but not commonly known cause of altered mental status and recurrent seizures.
Case reports: We describe two cases of military personnel who ingested C4 as part of a hazing ritual who presented to the emergency department with witnessed seizure, tremor and petechial rash. One of the patients had a second witnessed seizure within hours of ingestion. They were treated with intravenous benzodiazepines acutely, then with levetiracetam for 48 hours. Both patients were observed in the intensive care unit and discharged with no neurologic sequelae.
Discussion: C4 is a common military-grade explosive containing cyclonite which functions as a non-competitive, reversible GABAA antagonist and a rare but clinically significant cause of altered mental status and seizures when ingested. Management is primarily supportive with airway protection and treatment with GABAergic medication.
Keywords: Ingestion; Military personnel; Neurotoxin; RDX; Seizure.
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