Clinical and Medicolegal Aspects of Fatal Imidacloprid Deliberate Self-poisoning: A Case Report

Abstract

Background: Imidacloprid is a neonicotinoid insecticide and agonist of nicotinic acetylcholine receptors. Despite its low toxicity profile, there are rare studies on its fatal poisoning. In this report, we described clinical and postmortem findings of a fatal imidacloprid poisoning. Methods: A 33-year-old female presented to the emergency department with a history of deliberate consumption of unknown insecticide. On admission, she was drowsy and hypotensive with tachycardia and miotic pupils. Despite supportive therapy, she continued to be unconscious, with severe metabolic acidosis and developed a cardio-respiratory arrest and expired. Results: A forensic autopsy was performed. The result of the toxicological analysis showed that imidacloprid concentrations were 267.8 µg/mL in femoral blood, 144.5 µg/mL in stomach content, and 292.3 µg/mL in bile. Conclusion: Although imidacloprid is generally less toxic to humans high concentrations in biological samples could be considered lethal. Therefore, the educational programs about its toxicity should be considered for health care providers.

Neurotoxic Effects of Insecticides Chlorpyrifos, Carbaryl, Imidacloprid, in Different Animal Species

“…Drowsiness, confusion, incoherence, lack of orientation, and unconsciousness after acute poisoning [101]. Somnolence, Glasgow Coma Scale with a score of 10/15 and Miotic pupils after acute poisoning [102].…”

“…In bats, it has been related to a decrease in proteins related to echolocation in different brain regions [95]. Moreover, in humans, acute imidacloprid poisonings have been associated with neurological signs such as dyspnea, coma, sweating, drowsiness, confusion, incoherence, lack of orientation, and miotic pupils, among others [100][101][102]. In an in vitro study with LUHMES and SH-SY5Y cells, an increase in intracellular calcium levels was found [123] (Table 5) On the other hand, after acute poisoning, cerebral edema has been reported as a necropsy finding [101], while in an in vitro study it was revealed that it can cause the death of SH-SY5Y cells [135].…”