Pyrethrin, Pyrethroid Poisoning

 SUBSTANCE

-          Pyrethrin 除蟲菊精

-          Artificial: pyrethroid [1]

Common name or Trade name 

-          蚊香, 速必落, 滅飛, 拜貢, 克蟑[1]

 

Involving SYSTEM

-          delaying the closure of voltage-sensitive sodium channels. [1, 2]

-          Nearly 1% absorbed via skin [1]

-          GI discomfort [1, 2]

-          Airway irritative [1]

-          Bronchospasm [3]

-          Neurotoxic [2].

-          Cardiotoxic effects: prolonged bradycardia [2]

 

Presentation

-          Type I: T, tremor [1]

-          Tyee II: contains cyano-group, CS, choreoathetosis with salivation. [1]

-          Eye pain, tearing, and photophobia.[1]

-          Glasgow Coma Scale (GCS) <15 (33.9%) [4]

-          respiratory failure requiring ventilator care (17.9%) [4]

-          hypotension (10.7%), acute kidney injury (10.7%) [4]

-          pneumonia (7.1%) [4]

-          seizure (3.6%) and death (3.6%). [4]

 

Antidote and Treatment 

-          No antidote, supportive care. [1]

-          Using Bronchodilator when bronchospasm. [1, 5]

-          Decontamination [1]

-          Atropine improve the symptoms of type II pyrethrin related hypersecretion. [1]

-          Steroids, antihistamines and epinephrine PRN [5]

-          ACLS.

 

Disposition

-          Fatal dose when 10—100 gm. [1]

 

REFERENCES

1.      急診醫學會. 急性中毒救命術. 三版p.77—83.

2.      Shilpakar O, Karki B. Cypermethrin poisoning manifesting with prolonged bradycardia: A case report. Toxicol Rep. 2020 Dec 10;8:10-12. doi: 10.1016/j.toxrep.2020.12.005. PMID: 33364178; PMCID: PMC7750177.

3.      Wax PM, Hoffman RS. Fatality associated with inhalation of a pyrethrin shampoo. J Toxicol Clin Toxicol. 1994;32(4):457-60. doi: 10.3109/15563659409011049. PMID: 8057406.

4.      Cha YS, Kim H, Cho NH, Jung WJ, Kim YW, Kim TH, Kim OH, Cha KC, Lee KH, Hwang SO, Nelson LS. Pyrethroid poisoning: features and predictors of atypical presentations. Emerg Med J. 2014 Nov;31(11):899-903. doi: 10.1136/emermed-2013-202908. Epub 2013 Aug 19. PMID: 23959805.

5.      van den Bersselaar LR, van der Hoeven JG, de Jong B. Suicide after inhaling a pyrethrins containing insecticide spray. BMJ Case Rep. 2019 Apr 16;12(4):e227936. doi: 10.1136/bcr-2018-227936. PMID: 30996064; PMCID: PMC6506137.

edited by Yu-Jang Su    Nov 9, 2021.