We report an 89-year-old retired farmer with prolonged bradycardia and hypotension after pyrethroid insecticides ingestion in a suicidal attempt. This patient also had a clinical manifestation mimicking organophosphate poisoning, included confusion, lacrimation and salivation. He required intensive care support, atropine and inotrope infusions treatments. Only metabolites of synthetic pyrethroid insecticides (3-phenoxybenzoic acid and 3-phenoxybenzaldehyde) were detected in the urine sample. In the serum toxicology screening, specific analysis for organophosphate pesticides was negative. He eventually recovered without major sequela. (Hong Kong j.emerg.med. 2016;23:47-51)