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Pyrethroid poisoning: features and predictors of atypical presentations
Yong Sung Cha1, Hyun Kim1, Nam Hyub Cho1
1Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Kangwon, Republic of Korea.
Emergency Medicine Journal : EMJ
|August 21, 2013
Summary
Nearly 40% of pyrethroid poisoning cases present atypically, often with respiratory failure. Ingested amount over 250 cc and serum lactate over 3.5 mmol/L predict these severe outcomes.
Area of Science:
- Toxicology
- Emergency Medicine
- Clinical Chemistry
Background:
- Pyrethroids are widely used insecticides with generally low human toxicity.
- However, atypical systemic clinical features of pyrethroid poisoning are not well-defined.
- This study aimed to identify these presentations and their predictors in emergency settings.
Purpose of the Study:
- To investigate the clinical characteristics of atypical pyrethroid poisoning.
- To identify predictors of atypical presentations in patients presenting to the emergency department.
- To inform early diagnosis and management of severe pyrethroid poisoning.
Main Methods:
- Retrospective review of 59 pyrethroid poisoning cases treated at a single hospital from 2004-2012.
- Analysis of patient demographics, ingested amounts, clinical signs, and laboratory values.
- Statistical analysis to determine predictors of atypical presentations.
Main Results:
- Atypical presentations occurred in 39.3% of patients, including respiratory failure, hypotension, acute kidney injury, and seizures.
- Patients with atypical presentations were older and had ingested larger amounts of pyrethroids.
- Predictors for atypical presentations included ingested amount (>250 cc) and elevated serum lactate (>3.5 mmol/L).
Conclusions:
- A significant proportion of pyrethroid poisoning cases exhibit atypical clinical features.
- Respiratory failure was the most common atypical presentation.
- Early identification of ingested amount and serum lactate levels can predict severe outcomes in pyrethroid poisoning.
Keywords:
toxicology
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