Hypoglycemia and revisable ST-elevation induced by Movento

Spirotetramat (STM), an active ingredient of insecticide Movento 100 suspension concentrate (M100), is an inhibitor of acetyl-CoA carboxylase (ACC). The ACC is catalyst of acetyl-CoA to malonyl-CoA (MCA) reaction. MCA is the rate limiting steps of fatty acid biosynthesis. An 18-years-old man, who was referred to our ward from a local hospital, ingested 100 ml of M100, 18 h before. When we visited him, he was confused with stable vital signs and complained of vomiting and epigastric discomfort. He experienced hypoglycemia (blood sugar = 31 mg/dl) that was treated by hypertonic 20% dextrose serum and continued by maintenance DW10% (100 ml/h) up to 3 h. The first electrocardiogram showed ST-elevation. The results of urgent bedside echocardiography findings were normal. His first troponin I value was 0.01 ng/ml and at 1 and 6 h later were zero. The elevated ST segment gradually returned to baseline through next 6 h. STM ingestion can cause hypoglycemia and ST changes.