Parenteral organophosphorus poisoning in a rural emergency department: a case report

"The Toxic Depot": Parenteral Insecticide Injection

Background

Organophosphorus (OP) pesticides are extensively used both in developed and developing countries. Organophosphorus poisoning primarily occurs through occupational, accidental, and suicidal exposures. Toxicity through parenteral injections is seldom reported and there are only very few case reports till date.

Case presentation

We report a case of parenteral injection of 10 mL of OP compound (Dichlorvos 76%) into a swelling over the left leg. The compound was injected by the patient himself as adjuvant therapy for swelling. Initial manifestations included vomiting, abdomen pain, and excessive secretions followed by neuromuscular weakness. The patient was subsequently intubated and treated with atropine and pralidoxime. The patient did not improve with antidotes for OP poisoning, attributed to the depot the OP compound had formed. The swelling was excised and the patient immediately showed response to the treatment. Biopsy of the swelling showed granuloma and fungal hyphae. The patient developed intermediate syndrome during the ICU stay and was discharged after 20 days of hospital stay.

How to cite this article

Jacob J, Reddy CHK, James J. "The Toxic Depot": Parenteral Insecticide Injection. Indian J Crit Care Med 2022;26(7):877-878.

Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report

Background

The widespread use of pesticides in public health protection and agricultural pest control has caused severe environmental pollution and health hazards, especially in developing countries, including cases of severe acute and chronic human poisoning. Diabetic ketoacidosis is an uncommon manifestation of acute pesticide poisoning. Suicidal pesticide poisoning by injection is also an unusual way to take poison. We report a severe pesticide mixture poisoning case with diabetic ketoacidosis in an adult with improved outcome after supportive treatment and large doses of atropine.

Case presentation

A 30-year-old unmarried Moroccan Arab male with a previous history of active polysubstance abuse and behavior disorders had ingested and self injected intravenously into his forearm an unknown amount of a mixture of chlorpyrifos and cypermethrin. He developed muscarinic and nicotinic symptoms with hypothermia, inflammation in the site of the pesticide injection without necrosis. Red blood cell cholinesterase and plasma cholinesterase were very low (<10%). By day 3, the patient developed stroke with hypotension (80/50 mmHg) and tachycardia (143 pulses /min). Laboratory tests showed severe hyperglycemia (4.49 g/dL), hypokaliemia (2.4 mEq/L), glycosuria, ketonuria and low bicarbonate levels (12 mEq/L) with improvement after intensive medical treatment and treatment by atropine.

Conclusion

Suicidal poisonings with self-injection of insecticide were rarely reported but could be associated with severe local and systemic complications. The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis.