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Case report: Pesticide-related methemoglobinemia: Tebufenozide and indoxacarb poisoning
Jieru Wang1,2, Guangcai Yu2,3, Tianzi Jian2
1Department of Critical Care Medicine, The 5th People's Hospital of Jinan, Jinan, Shandong, China.
Background:
Methemoglobinemia can be inherited or acquired. Acquired forms are more common due to drugs or poisonous substances that oxidize hemoglobin, and pesticide-related cases are notably rare.
Case Presentation:
We report a 69-year-old woman who ingested 30 mL of tebufenozide and indoxacarb and was asymptomatic for 3 h; however, the patient was admitted to the hospital after 8 h, unconscious, with tachypnea, cyanosis, and 61.9% methemoglobin. The patient was administered methylene blue, mechanically ventilated, and hemoperfused. Subsequently, the patient recovered and was discharged with no discomfort and with normal laboratory test results.
Conclusion:
Tebufenozide and indoxacarb may cause methemoglobinemia, leading to cyanosis, unconsciousness, and respiratory failure; therefore, they should be handled with care in clinical practice.
Insights
Pesticide ingestion, specifically tebufenozide and indoxacarb, can cause acquired methemoglobinemia. Prompt treatment with methylene blue and supportive care led to a patient's full recovery.
Area of Science:
- Toxicology
- Environmental Health
Background:
- Methemoglobinemia is a condition where hemoglobin is oxidized, reducing oxygen transport.
- Acquired methemoglobinemia is more common than inherited forms, often caused by drug or toxin exposure.
- Pesticide-induced methemoglobinemia is considered rare in clinical practice.
Observation:
- A 69-year-old woman presented with severe symptoms including unconsciousness, tachypnea, and cyanosis 8 hours after ingesting 30 mL of tebufenozide and indoxacarb.
- Initial laboratory tests revealed a methemoglobin level of 61.9%.
Findings:
- The patient received treatment with methylene blue, mechanical ventilation, and hemoperfusion.
- Tebufenozide and indoxacarb exposure were identified as the likely cause of the acquired methemoglobinemia.
- The patient demonstrated a full recovery with no residual symptoms or abnormal laboratory findings upon discharge.
Implications:
- Tebufenozide and indoxacarb are potential causes of methemoglobinemia, necessitating careful handling in clinical settings.
- Early recognition and aggressive management are crucial for favorable outcomes in pesticide-induced methemoglobinemia.
- This case highlights the importance of considering pesticide exposure in the differential diagnosis of unexplained methemoglobinemia.
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