Corrosive / Caustic Injury — Acids vs. Alkalis

 

Substances & Common Names

• Acids (酸)
• Hydrochloric acid (鹽酸，除鏽劑、清潔劑)[1]
• Sulfuric acid (硫酸，汽車電池液) [2]
• Nitric acid (硝酸，肥料/工業)[3]
• Hydrofluoric acid (氫氟酸，玻璃蝕刻、金屬清潔)[4]
• Alkalis (鹼)
• Sodium hydroxide (氫氧化鈉/苛性鈉，水管疏通劑)[5].
• Potassium hydroxide (氫氧化鉀，烤箱清潔劑)[6].
• Calcium hydroxide (氫氧化鈣，石灰) [7].
• Ammonia (氨水，清潔劑/工業) [8].
• Sodium hypochlorite (次氯酸鈉，家用漂白水 3–6%) [9].

---

Involving Systems

• 主要影響：GI tract、airway、eyes、skin [1], [5], [9]
• 酸 → coagulative necrosis，表層壞死較多，但也可穿孔 [1]
• 鹼 → liquefactive necrosis，深層滲透壞死 → 食管灼傷更嚴重 [10].

---

Presentation

• 共同表現：
• 咽喉痛、流涎、吞嚥困難、嘔吐、胸/腹痛 [1]
• 嚴重 → 上消化道出血、穿孔、縱隔炎、呼吸困難 [1]
• 酸特徵 (尤其 HF)：
• 胃為主要損傷部位 [1]
• HF：低血鈣、心律不整、QT 延長 [4]
• 鹼特徵：
• 深入食管 → 高風險穿孔、狹窄 [6]
• 常見氣道水腫、聲音沙啞、呼吸窘迫 [6]

---

Antidote

• 一般酸/鹼：無特效解毒劑[6]
• HF 特例：Calcium gluconate (IV 或 topical gel) [4]

---

Disposition / Management [1, 4, 6]

• Immediate
• Airway first：出現聲音沙啞、喘鳴、流涎 → 早期插管
• 禁止催吐、洗胃、活性碳
• 可給予牛奶/水少量稀釋 (非強制)
• Evaluation
• 12–24 小時內胃鏡檢查 (避免 >48 小時)
• 影像檢查 (CT) 若懷疑穿孔
• Treatment
• Supportive care, IV fluids, pain control
• 類固醇：具爭議，可能降低食管狹窄，但感染風險 ↑
• 外科手術：穿孔、廣泛壞死時
• Long-term
• 食管狹窄 (最常見後遺症)
• 增加食管癌風險 (特別是鹼灼傷)

---

References

• [1].Yu CH, Su YJ, Lai YC. Fatal Zargar grade 3b corrosive injury after hydrochloric acid ingestion: A case report. Medicine (Baltimore). 2024 Oct 4;103(40):e40017. doi: 10.1097/MD.0000000000040017. PMID: 39465708; PMCID: PMC11460919.
•  
• [2]. Mastrodicasa E. Sulfuric Acid Ingestion: May the Severity of the Metabolic Acidosis be Considered as a Predictive Sign of Late Damage to the Gastrointestinal Tract? Eur J Case Rep Intern Med. 2024 Apr 9;11(5):004437. doi: 10.12890/2024_004437. PMID: 38715891; PMCID: PMC11073603.
•  
• [3]. Colalillo JM, Skinner K. Why so blue? A novel presentation of methaemoglobinaemia secondary to an inhaled occupational nitric acid exposure. Clin Toxicol (Phila). 2025 Feb;63(2):145-147. doi: 10.1080/15563650.2024.2440547. Epub 2024 Dec 18. PMID: 39692141.
•  
• [4].Su YJ, Lu LH, Choi WM, Chang KS. Survival after a massive hydrofluoric acid ingestion with ECG changes. Am J Emerg Med. 2001 Sep;19(5):458-60. doi: 10.1053/ajem.2001.24503. Erratum in: Am J Emerg Med. 2009 Jan;27(1):126. PMID: 11555812.
•  
• [5].Barnes SS, Wong W Jr, Affeldt JC. A case of severe airbag related ocular alkali injury. Hawaii J Med Public Health. 2012 Aug;71(8):229-31. PMID: 22900239; PMCID: PMC3419824.
•  
• [6].Chibishev A, Pereska Z, Chibisheva V, Simonovska N. Corrosive poisonings in adults. Mater Sociomed. 2012;24(2):125-30. doi: 10.5455/msm.2012.24.125-130. PMID: 23678319; PMCID: PMC3633385.
•  
• [7].Schmidt SM, Schmidt CJ, Adler M, Rahmani B. Corneal injury due to a calcium hydroxide containing food preparation product ("cal"). Pediatr Emerg Care. 2008 Jul;24(7):468-70. doi: 10.1097/PEC.0b013e31817de2d3. PMID: 18633308.
•  
• [8].Czerwiec A, Chevallier C, Grenet G, Patat AM, de Souza S, Lichtfouse J; French Poison Centres Research Group; Boucher A, Paret N; List of French Poison Centres (Centre antipoison). Exposure to ammonia solution due to substance use: a retrospective study from the French poison centres database (2009-2018). Clin Toxicol (Phila). 2024 Feb;62(2):107-111. doi: 10.1080/15563650.2024.2313088. Epub 2024 Feb 28. PMID: 38416057.
•  
• [9].Patterson J, Vallance V. Severe chemical pneumonitis following exposure to household bleach. BMJ Case Rep. 2025 Mar 27;18(3):e262924. doi: 10.1136/bcr-2024-262924. PMID: 40147947.
•  
• [10].Boonekamp C, Voruz F, Fehlmann C. Accidental aspiration of a solid tablet of sodium hydroxide. BMJ Case Rep. 2018 Jun 21;2018:bcr2018224213. doi: 10.1136/bcr-2018-224213. Erratum in: BMJ Case Rep. 2018 Aug 17;2018:bcr-2018-224213corr1. doi: 10.1136/bcr-2018-224213corr1. PMID: 29930183; PMCID: PMC6020962.
• 
  

Edited by Yu-Jang Su       Aug 21, 2025

•  

Giant Hogweed: An Invasive Threat to Health and Environment

  News 

Substance The primary hazard associated with giant hogweed lies in its sap, which contains furocoumarins or psoralens[1]. These phototoxic compounds are found throughout the plant, with the highest concentrations notably present in its fruits, leaves, and stem[1].

Importantly, the sap can retain its toxicity on exposed clothing for several hours after contact[1]. The concentration of these phototoxic compounds in giant hogweed is highest during the months of June, July, and August, aligning with periods of increased outdoor human activity[1].

 

Common Name Giant hogweed (Heracleum mantegazzianum) is a highly invasive flowering weed

Massive Size: A towering monocarpic perennial, reaching 3–5.5 meters tall with large leaves and white umbrella-shaped flowers.
[1][2] 

Origin & Spread: Native to the Caucasus, introduced to the UK in the 19th century, and later spread across Europe, the U.S. (1917), and Canada (1949).
[1][2]

Invasive Status: Listed as an invasive alien species of Union concern; ranked 22nd among Europe’s top 149 invasive species.
[2]

Habitat Range: Thrives in diverse areas—riversides, roadsides, fields, and even seashores—due to high adaptability.
[1][2]

Czech Distribution Example:In the Czech Republic, 84.7% grow in fields, 13.7% in forests, and just 1.6% in urban areas.
[2]

 

Involving System Contact with giant hogweed sap primarily affects the following systems:

●     Skin: Leading to a severe inflammatory reaction known as photophytodermatitis[1][2]. This is a non-immunologic form of dermatitis[1].[3]

●     Eyes: Direct eye contact with the sap can result in blindness[1][2].

●     Respiratory System: Inhalation of plant traces may cause obstructive pulmonary symptoms[1].

Presentations

Photophytodermatitis is triggered when UVA light activates furocoumarins (psoralens) in the plant sap, producing reactive oxygen species and DNA intercalation, leading to cell death and impaired healing [2]. Symptoms may begin within 15 minutes of exposure, with visible signs like erythema and edema typically appearing after 24 hours and peaking at 72 hours [1][2].

Skin injury ranges from mild redness to full-thickness chemical burns requiring debridement and grafting [1][2][4]. Severity increases with greater sap contact, sun exposure, humidity, heat, infection, and lack of protective clothing. Long-term hyperpigmentation can persist for weeks [1].

Photodistribution and Case Example:
The rash mainly appears on sun-exposed skin [2]. A 27-year-old landscaper trimming tall giant hogweed without protection developed severe blistering on his arms and neck, including large bullae (3–4 cm) and marked edema; his coworkers had milder reactions [1].

 

Antidote/Treatment

Effective management of giant hogweed exposure involves immediate action and symptomatic treatment:

●     Immediate Response: Upon contact with giant hogweed, it is crucial to immediately avoid any further UV exposure[1]. The affected area should be thoroughly rinsed with soap and water[1][2]. It is imperative to avoid UV radiation for at least 48 hours following exposure[1].

●     Topical Treatment: For mild reddening or erythema, a topical steroid can be applied to the affected area[1].

●     Pain Management: Pain can be alleviated by using a nonsteroidal anti-inflammatory drug[1].

●     Blister Management:

○     Small blisters can be carefully punctured and drained[1].

○     However, for large blisters, extensive epidermal-dermal separation, or large areas of detached epidermis, the recommendation is to simply cleanse and dress the affected area without puncturing[1].

●     Systemic Treatment: In cases of moderate to severe inflammation, an oral steroid may be prescribed. For instance, a patient was successfully treated with oral prednisone 70 mg daily (1 mg/kg/d), with the dosage gradually decreased by 10 mg every three days until the course was complete[1].

●     Surgical Intervention: Full-thickness chemical burns may necessitate surgical debridement and skin grafting[1].[5]

●     Post-Treatment Care: To manage open areas, mupirocin ointment can be applied, while petroleum jelly is recommended for intact skin[1]. Patients are also advised to practice strict photoprotection for both the immediate and long-term future[1].

Disposition

The prognosis for giant hogweed phytophotodermatitis, with appropriate treatment, can be favorable. In one clinical case, the severe phytophotodermatitis dramatically improved within several days, with complete resolution observed in one week. Postinflammatory hyperpigmentation, a common sequela, resolved after several weeks[1].

However, the broader implications of giant hogweed extend beyond individual health outcomes, encompassing significant economic and public health impacts across regions[1][2].

Public Health Impacts:

 

●     The large size and "charismatic" nature of the plant make it particularly dangerous for unsuspecting visitors or tourists, contributing to the risk of injury. Dense populations can physically impede access to valued amenity areas and reduce visibility along roadsides[2].

Management and Prevention Strategies:

Due to the phototoxicity of giant hogweed sap, control requires trained personnel with protective gear [1]. The plant is extremely invasive, producing up to 50,000 seeds per plant with a ~90% germination rate, making eradication long-term and resource-intensive [2]. Misidentification with native plants like Angelica or wild parsnip complicates detection [2]. In high-traffic areas, authorities may need to restrict public access to reduce human contact risk [2].

Although giant hogweed’s spread in North America has been relatively slow, European cases show that delayed action can lead to exponential invasion, escalating both health and economic impacts [1]. Early detection and rapid response are essential for cost-effective control. Regions bordering known invasion zones (e.g., Kentucky, Missouri, Tennessee) and underreported areas (e.g., New Hampshire) should stay vigilant to prevent widespread establishment [2].

---

References

1. Cuddington K, Sobek-Swant S, Drake J, Lee W, Brook M. Risks of giant hogweed (Heracleum mantegazzianum) range increase in North America. Biol Invasions. 2022;24:299–314.
2. Flanagan KE, Blankenship K, Houk L. Botanical Briefs: Phytophotodermatitis Caused by Giant Hogweed (Heracleum mantegazzianum). Cutis. 2021;108:251-253.
3. Lagey K, Duinslaeger L, Vanderkelen A. Burns induced by plants. Burns. 1995 Nov;21(7):542-3. doi: 10.1016/0305-4179(95)00026-8. PMID: 8540985.
4. .Chan JC, Sullivan PJ, O'Sullivan MJ, Eadie PA. Full thickness burn caused by exposure to giant hogweed: delayed presentation, histological features and surgical management. J Plast Reconstr Aesthet Surg. 2011 Jan;64(1):128-30. doi: 10.1016/j.bjps.2010.03.030. Epub 2010 Apr 15. PMID: 20399165.
5. Baker BG, Bedford J, Kanitkar S. Keeping pace with the media; Giant Hogweed burns - A case series and comprehensive review. Burns. 2017 Aug;43(5):933-938. doi: 10.1016/j.burns.2016.10.018. Epub 2016 Dec 29. PMID: 28041748

Edited by   Hsiu-Wu Yang and   Yu-Jang Su

July 6, 2025     

 

Gender Differences in Hymenoptera Stings

 

 Substance:

Hymenoptera venom

 Common name:

Bee, wasp, hornet, stings

 

 Involving system:

Immune system: IgE-mediated hypersensitivity [1].

Cardiovascular system: Hypotension, anaphylactic shock [2]

Respiratory system: Bronchospasm, airway edema [3]

Dermatologic system: Urticaria, angioedema, erythema [4, 5]

Neurological/psychological: Panic, fear, anxiety—especially pronounced in females [6].

 

 Presentation:

Most stings cause local reactions (pain, swelling, redness).

Large local reactions (LLRs): >10 cm swelling over 24–48 hours, typically benign. [7]

Systemic reactions (SRs): Include generalized urticaria, dyspnea, hypotension, collapse. [5, 8]

Anaphylaxis: Life-threatening; rapid onset of multisystem involvement.

 

Gender differences:

Females tend to report more severe subjective symptoms (pain, anxiety), and have higher rates of anxiety and PTSD after stings. A significant percentage of stings in females occurred on holidays (47.8% vs. 26.8%, p = 0.008), and drop in DBP was more noticeable in females (76.3 vs. 70.3 mmHg). [5].

Males are more likely to experience systemic reactions, possibly due to occupational/environmental exposure (e.g., agriculture, outdoor work). Males experiencing significantly more Hymenoptera stings (1.3 vs. 1.0, p = 0.049) [5]

Males are also less likely to carry epinephrine autoinjectors and adhere to follow-up, whereas females are more compliant with allergist visits and venom immunotherapy (VIT) [9].

 .

 Antidote / Management:

No specific antidote. 

Wound care, Tetanus Toxoid injection. 

First-line: Intramuscular epinephrine (0.3 mg adult; 0.15 mg pediatric) in SRs [5, 10] 

Supportive care: Oxygen, IV fluids, bronchodilators, corticosteroids, H1/H2 antihistamines [5]

Venom immunotherapy (VIT): Highly effective long-term desensitization for patients with systemic allergic reactions. [9]

 

 Disposition:

Mild local reactions: Discharge with symptomatic care (cold compress, antihistamines, NSAIDs)

Anaphylaxis/systemic reactions: Admit or observe in ED; consider ICU for severe cases

Educate patient and caregivers on sting avoidance, epinephrine use, and emergency action plan

 

References

[1] Sturm GJ, Heinemann A, Schuster C, Wiednig M, Groselj-Strele A, Sturm EM, Aberer W. Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy. Allergy. 2007 Aug;62(8):884-9. doi: 10.1111/j.1398-9995.2007.01413.x. PMID: 17620065.

[2] van der Linden PW, Struyvenberg A, Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after insect-sting challenge in 138 persons with a previous insect-sting reaction. Ann Intern Med. 1993 Feb 1;118(3):161-8. doi: 10.7326/0003-4819-118-3-199302010-00001. PMID: 8417633.

[3] Mayer DE, Krauskopf A, Hemmer W, Moritz K, Jarisch R, Reiter C. Usefulness of post mortem determination of serum tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis. Forensic Sci Int. 2011 Oct 10;212(1-3):96-101. doi: 10.1016/j.forsciint.2011.05.020. Epub 2011 Jun 12. PMID: 21664082.

[4] Colombi S, Cantone R, Massara G, Parachini F, Petrella V, Pastore M, Galimberti M. Reazioni da imenotteri: un problema di pronto soccorso [Reactions caused by Hymenoptera: a first aid problem]. Minerva Med. 1988 Jul;79(7):539-42. Italian. PMID: 3405456.

[5] Yu CH, Tan ST, Yang HW, Lai YC, Su YJ. Gender-Based Clinical Differences in Hymenoptera Venom Poisoning: A Retrospective Study From Taiwan (April 2021 to March 2023). Emerg Med Int. 2025 Jun 2;2025:8893175. doi: 10.1155/emmi/8893175. PMID: 40495953; PMCID: PMC12149513.

[6] Woźniewicz A, Szynkiewicz E, Pałgan K, Graczyk M, Dowbór-Dzwonka A, Bartuzi Z. Fear of stinging insects in relation to state anxiety and trait anxiety in a group of patients with hymenoptera venom allergy undergoing immunotherapy. Postepy Dermatol Alergol. 2019 Aug;36(4):472-477. doi: 10.5114/ada.2018.78808. Epub 2019 Aug 30. PMID: 31616224; PMCID: PMC6791157.

[7] .Bilò MB, Martini M, Pravettoni V, Bignardi D, Bonadonna P, Cortellini G, Kosinska M, Macchia D, Mauro M, Meucci E, Nittner-Marszalska M, Patella V, Pio R, Quercia O, Reccardini F, Ridolo E, Rudenko M, Severino M. Large local reactions to Hymenoptera stings: Outcome of re-stings in real life. Allergy. 2019 Oct;74(10):1969-1976. doi: 10.1111/all.13863. Epub 2019 May 28. PMID: 31074868.

[8].Chang CW, Chen HY, Mao CY, Lin YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184. doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.

[9].Bilò BM, Bonifazi F. Hymenoptera venom immunotherapy. Immunotherapy. 2011 Feb;3(2):229-46. doi: 10.2217/imt.10.88. PMID: 21322761.

[10]. Sicherer SH, Simons FER; SECTION ON ALLERGY AND IMMUNOLOGY. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics. 2017 Mar;139(3):e20164006. doi: 10.1542/peds.2016-4006. Epub 2017 Feb 13. PMID: 28193791.

Edited by Yu-Jang Su   June 20, 2025, 

                                      June 21, 2025 revised. 

Hymenoptera Stings in Taiwan: Wasps and Bees

 

Substances

Common Names

Wasps (family Vespidae, including hornets and paper wasps)

Bees (family Apoidea, including honeybees)

 

Involved Systems

Immune system (anaphylactic reactions)

Renal system (acute kidney injury from multiple stings) [1]

Hepatic system (elevated liver enzymes) [1]

Muscular system (rhabdomyolysis) [2]

Hematologic system (coagulopathy, hemolysis) 22.5% [3]

 

Presentations

Older adult patients are more frequently stung on the head and upper limbs [1].

Local reactions such as pain, redness, and swelling are more common and milder in bee stings.

Systemic reactions—especially with wasp stings—include anaphylaxis, hypotension, dyspnea, and urticaria. Severe wasp stings can lead to rhabdomyolysis, acute renal failure, liver injury, and disseminated intravascular coagulation (DIC). [1]
Severity factors include advanced age, multiple body regions affected, and a high number of stings (particularly >50). Older patients tend to have slower heart rates (85.7 vs. 92.4 bpm, p = 0.003) and significantly higher creatine kinase (CK) levels (1343.3 vs. 239.5 U/L, p = 0.003) [1]

 

Antidotes / Treatment

Mild to Moderate Cases:

Antihistamines and corticosteroids [1]

Analgesics for pain control [1]

Severe or Anaphylactic Reactions: Intramuscular epinephrine

Intravenous fluids, oxygen, vasopressors if needed

Intensive care support for rhabdomyolysis or renal failure

Hemodialysis in cases of renal impairment

 

Disposition

About 7.5% of Hymenoptera sting cases result in severe or fatal envenomation [4].
Bee stings usually lead to mild outcomes—most patients recover without complications and rarely require hospitalization.
In contrast, wasp stings pose a higher risk for ICU admission and mortality, especially when sting number exceeds 50.

Key severity predictors include:

• Three or more stings (OR: 35.87, p = 0.002) or sting sites (OR: 35.2, p = 0.002) [1]
• Greater number of stings, wasp species, older age, and stings over multiple body regions [4].
  Wasp stings are more frequently associated with life-threatening outcomes in Taiwan, with incidence peaking from late summer to early autumn.
  Although about 25% of systemic allergic reactions are severe, fatal outcomes are rare (0.004) [1].
  
  There is still a need to improve public awareness and the proper use of epinephrine in managing anaphylaxis.

 

References

1.      Chang CW, Chen HY, Mao CY, Lin YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184. doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.

2.      Lin CC, Chang MY, Lin JL. Hornet sting induced systemic allergic reaction and large local reaction with bulle formation and rhabdomyolysis. J Toxicol Clin Toxicol. 2003;41(7):1009-11. doi: 10.1081/clt-120026527. PMID: 14705851.

3.      Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One. 2013 Dec 31;8(12):e83164. doi: 10.1371/journal.pone.0083164. PMID: 24391743; PMCID: PMC3877022.

4.      Nguyen TN, Jeng MJ, Chen NY, Yang CC. Outcomes of wasp and bee stings in Taiwan. Clin Toxicol (Phila). 2023 Mar;61(3):181-185. doi: 10.1080/15563650.2023.2173075. Epub 2023 Mar 9. PMID: 36892552.

Edited by Yu-Jang Su May, 6, 2025. 

 

Emamectin Poisoning

 

Substance:

Emamectin – A semi-synthetic avermectin derivative used as an insecticide. It acts by activating glutamate-gated chloride channels in invertebrates, leading to paralysis and death [1].

- Similar to ivermectin, it can also affect GABA-mediated neurotransmission at higher doses. [2]

-a broad-spectrum insecticide [3].

-      Poisoned age: 42.8 to 72 years old. [1, 3, 4]

-      Happened to Male 72.7% [3].

 

Common Names:

Emamectin; commonly found in agricultural products under trade names such as Proclaim, Affirm, or Tree-äge.

It is not intended for human or veterinary use.

因滅汀; 迅雷; 霸蟲清; 治蟲王, 阿巴汀. [5].

 

Involving Systems:

Primarily affects:

-      Potential mechanisms of corrosive injury include skin and eye irritation effects of EMB, the solvents of which might exert corrosive action [1, 6].

-      Central Nervous System (CNS) [1]. 27.3% [3],[4], and [6].  

-      Gastrointestinal System (GI) distress [1] 62.5% [3], and [6].

-      Respiratory symptoms (6.8%) [3]. 9-27 % intubation. [3, and 4].

-      SOB 33% [4].

 

Presentation:

Symptoms vary by dose and individual sensitivity, and may include:

-      Altered mental status, AMS [1] can breach the blood-brain barrier

-      Drowsiness [4], dizziness, ataxia, muscle weakness

-      Sore throat. [1, 6] laryngeal corrosive injuries.

-      22% Nausea, vomiting [4], abdominal pain [5], diarrhea

-       Severe cases: respiratory depression [5], prolonged coma

 

Antidote:

-      No specific antidote available [1]  Supportive care is the cornerstone of treatment:

-      Maintain airway and provide oxygen as needed; intubation in severe cases

-      Monitor and support vital signs

-      Activated charcoal may be administered if within 1 hour of ingestion and no aspiration risk [5].

 

Disposition:

Mild cases: Can be monitored as outpatient for 6 hours;

Asymptomatic patients may be discharged

-Hospitalized (78% to 78.4%) [3, 4].

Moderate to severe toxicity: Requires inpatient observation; ICU care (42%) may be necessary in severe CNS or respiratory depression. [1, 4]

-      2.3% mortality. Consciousness is a prognostic outcome. [3]. A low GCS at presentation and SOB were associated with worse outcomes [4].

 

  

 

References

[1]. Pan CS, Lee CC, Yu JH, Mu HW, Hung DZ, Chen CH. Reassessing clinical presentations of emamectin benzoate poisoning: A comprehensive study. Hum Exp Toxicol. 2024 Jan-Dec;43:9603271241249965. doi: 10.1177/09603271241249965. PMID: 38662433

[2]. Lalmalsawmi R, Ravikumar YS, Mahesh M, Shihuna PMM, Ramesh M, Chalasani SH. Management and prognosis of acute Emamectin Benzoate poisoning in a human. Toxicol Rep. 2024 Sep 21;13:101744. doi: 10.1016/j.toxrep.2024.101744. PMID: 39399096; PMCID: PMC11470463.

[3].Trakulsrichai S, Sittiyuno P, Tansuwannarat P, Tongpoo A. Emamectin Poisoning in Thailand: Clinical Characteristics and Outcomes. Toxics. 2024 Sep 13;12(9):668. doi: 10.3390/toxics12090668. PMID: 39330596; PMCID: PMC11435638.

[4]. Wu YK, Chang CH, Yu JH, Lan KP, Yen TH, Chang SS, Seak CJ, Chang HY, Chen HY. Intentional avermectin pesticide ingestion: a retrospective multicenter study. Clin Toxicol (Phila). 2022 Oct;60(10):1099-1105. doi: 10.1080/15563650.2022.2104729. Epub 2022 Aug 2. PMID: 35916769.

[5]. https://www.sem.org.tw/Ejournal/Detail/549.

[6.]. Pan CS, Chen CH, Mu HW, Yang KW. Review of Emamectin Benzoate Poisoning. J Acute Med. 2024 Sep 1;14(3):101-107. doi: 10.6705/j.jacme.202409_14(3).0001. PMID: 39229355; PMCID: PMC11366691

 

Edited by Yu-Jang Su on April 12, 2025.