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.