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Determination of the Absorption, Translocation, and Distribution of Imidacloprid in Wheat
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Chlorfenapyr poisoning: a systematic review.

Grant Thomas Comstock1, HoanVu Nguyen2, Alvin Bronstein3

  • 1Department of Emergency Medicine, Division of Medical Toxicology, Medical College of WI, Milwaukee, WI, USA.

Clinical Toxicology (Philadelphia, Pa.)
|July 10, 2024
PubMed
Summary

Acute human chlorfenapyr poisoning presents with a latent period, rapid deterioration, and high mortality. A conservative management approach with close monitoring and supportive care is recommended for chlorfenapyr exposure.

Keywords:
Chlorfenapyrinsecticidepesticidepoisoningtralopyril

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Area of Science:

  • Toxicology
  • Environmental Health
  • Clinical Medicine

Background:

  • Chlorfenapyr is a broad-spectrum insecticide requiring biotransformation to its active form, tralopyril, for insecticidal activity.
  • The metabolism of chlorfenapyr and the precise mechanism of tralopyril toxicity in humans are not fully understood.
  • Acute human chlorfenapyr poisoning is poorly characterized, with unclear best practices for management.

Approach:

  • A systematic review of human chlorfenapyr and tralopyril poisoning cases was conducted.
  • Databases searched included PubMed, Web of Science, Google Scholar, and EMBASE up to April 2024.
  • Inclusion criteria focused on human exposures with clinical manifestations and course, excluding animal and non-clinical studies.

Key Points:

  • 48 publications describing 75 unique cases of chlorfenapyr poisoning were identified, with no tralopyril exposures reported.
  • Common initial symptoms include diaphoresis, nausea/vomiting, and altered mental status; hyperthermia developed in 61% and was linked to mortality.
  • Elevated creatine kinase, hepatic aminotransferases, and lactate were frequent; CNS imaging showed white matter abnormalities.

Conclusions:

  • Acute chlorfenapyr poisoning involves a latent period, potential for rapid deterioration, significant morbidity, and high mortality (76% case fatality).
  • Hyperthermia is an ominous sign associated with clinical decompensation and death.
  • A conservative management strategy emphasizing close monitoring and supportive care is advised due to unclear intervention effectiveness.