Cardiac Conduction Disturbance Due To Prallethrin (Pyrethroid) Poisoning

Abstract

Pyrethroids are common household insecticides. Even though they are less toxic to humans, reports of accidental and suicidal poisoning are not uncommon. Cardiotoxicity due to pyrethroid poisoning is rare. We report a case of cardiac conduction disturbance due to a pyrethroid, prallethrin. A 28-year-old female presented after a suicidal consumption of prallethrin. Her clinical and laboratory parameters were normal during the first 24 h of hospital stay. On the second hospital day, she developed metabolic acidosis and sinus arrest with escape junctional rhythm. Despite correction of metabolic acidosis, the sinus arrest persisted for 3 days. She reverted back to sinus rhythm with bradycardia after this period and was discharged on the seventh hospital day. Her follow-up was uneventful. Pyrethroid poisoning can affect the gastrointestinal, respiratory, and nervous system. Most serious effects of the toxin in humans are seizures and coma. Mechanism of pyrethroid neurotoxicity is believed to be due to its ability to modify sodium, chloride, and calcium channels of the neurons. Our case raises the possibility that cardiac arrhythmia due to pyrethroid poisoning can occur due to its effect on sodium channels in the heart.

Transient Complete Heart Block Secondary to Bed Bug Insecticide: A Case of Pyrethroid Cardiac Toxicity

“…The conduction system disorder caused by pyrethroids is even rarer (<1%). Bhaskar et al [8] reported a case of sinus arrest with junctional escape rhythm in a patient with an intentional overdose of prallethrin. The patient spontaneously converted to normal sinus rhythm after a few days of hospitalization with an uneventful course.…”

Environmental Toxins and the Heart

“…303 Inhalation or oral ingestion of pyrethrin insecticides may lead to paresthesias, headache, nausea, vomiting, diarrhea, melena, epigastric pain, dyspnea, bronchospasm, chest pain, neural excitability, and seizures. 303,304 Cardiovascular toxicities reported with pyrethroid exposure include hypotension, sinus tachycardia, sinus arrest (with junctional escape rhythm), 304 aortic dissection, depressed left ventricular systolic function, 305 and takotsubo cardiomyopathy. 288 Pyrethroid-induced toxicity most often resolves spontaneously within 48 hours after exposure with supportive care alone.…”

Impact of Acute Deltamethrin Poisoning on Rat Adrenal Glands: Biochemical and Pathomorphological Study

“…(1) These effects can be accompanied by the development of other undesirable effects that involve the reproductive, (2,3) immune, (4,5) cardiovascular, (6,7) respiratory (8,9) and other systems, and also contribute to a high risk of cancer development. (10) People contact pyrethroids when they are used in industrial activities and households, as well as from consumption of vegetables, fruits and water contaminated with their residues.…”