Management of indoxacarb poisoning in a regional setting

Firoozabadi, Ali Sobhani; Nasri-Nasrabadi, Zeynab; Marashi, Sayed Mahdi

doi:10.4103/0972-5229.192067

Cited by 4 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acquired methemoglobinemia results from exposure to drugs or toxins that cause oxidation of hemoglobin. When methemoglobin formation overwhelms protective enzyme systems, its levels rise and cause diminished oxygen delivery to tissues [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

Sivanandam,

Arunkumar,

Marlecha

et al. 2024

J Med Case Reports

View full text Add to dashboard Cite

Introduction This case study reports on a suicide attempt involving indoxacarb and vitamin C. Indoxacarb is a neurotoxic insecticide used in agriculture and as a flea controller in pets. Cotton, vegetables, and fruits are treated with indoxacarb, an insecticide that can be applied both indoors and outdoors. It causes skin allergies, methemoglobinemia, and hemolytic anemia. It is also attributed to allergic reactions through ingestion, inhalation, physical contact, and translaminar action. This case report highlights use of vitamin C in methemoglobinemia caused by indoxacarb poisoning. Indoxacarb poisoning has the potential to be extremely serious and even lethal. In this instance, the patient initially had no symptoms after ingesting a substance containing indoxacarb in an attempt at suicide. However, further tests revealed methemoglobinemia and low oxygen levels. Case presentation A 28-year-old south-east Asian female patient ingested an insecticide containing 5.25% novaluron, 4.5% indoxacarb, and 25% thiamethoxam, and reported that she noticed muddy brown urine but presented with no active signs or symptoms of poisoning. Upon examination, the patient was fully conscious, alert, and hemodynamically stable, but had an oxygen saturation of 84%. Gastric lavage was performed, and blood investigations revealed a muddy-brown-colored blood sample and methemoglobin levels of 12%. The patient was treated with high-dose vitamin C and showed significant improvement, with a drop in methemoglobin levels to 1.2% and an increase in oxygen saturation to 97%. Discussion Indoxacarb poisoning can cause severe methemoglobinemia. Vitamin C may be a useful treatment option for methemoglobinemia caused by indoxacarb, particularly in cases in which traditional treatment with methylene blue is contraindicated or not tolerated. Hence high doses of ascorbic acid, that is, vitamin C, were administered to the patient, which lowered their methemoglobin levels and improved oxygen levels without much safety concerns. Conclusion This example emphasizes the significance of early indoxacarb poisoning detection and treatment as well as the possible advantages of utilizing ascorbic acid in the management of methemoglobinemia, and highlights the use of vitamin C in the treatment of methemoglobinemia caused by indoxacarb poisoning. Therefore, it is important for healthcare professionals to be aware of the potential for indoxacarb to cause methemoglobinemia and to consider vitamin C as a treatment option.

show abstract

Section: Discussionmentioning

confidence: 99%

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

Sivanandam,

Arunkumar,

Marlecha

et al. 2024

J Med Case Reports

View full text Add to dashboard Cite

show abstract

“…Other studies in Iran investigated the effect of exposure to other drugs and toxic substances such as aluminum phosphide, indoxacarb and vitamins. However, as they were case reports, they were of low methodological value (14-17). It is worth mentioning that the limited number of studies in different parts of the world makes it difficult to compare our results with similar studies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Abnormal Methemoglobinemia and Its Determinants in Patients Receiving Nitroglycerin During Anesthesia

et al. 2019

View full text Add to dashboard Cite

Background One of the complications of nitroglycerin infusion during surgery is methemoglobinemia. Objectives The aim of this study was to investigate the prevalence of methemoglobinemia and its association with nitroglycerin infusion for the treatment of hypertension during general anesthesia. Methods Patients received nitroglycerin infusion at a dose of 2 μ/kg/min. The aim of controlling blood pressure was to set the blood pressure at 20% of the patient’s baseline. Then, the amount of methemoglobin was recorded at 15-minute intervals. Backward stepwise logistic regression test was used to determine the factors affecting methemoglobinemia. Results Based on the criterion of methemoglobin level above 2%, the prevalence of pathologic methemoglobinemia was 56.6%. After adjusting for confounding variables in the final model, the total prescribed dose was the only factor affecting pathologic methemoglobinemia. Conclusions For the first time, we showed that more than half of the patients undergoing surgery suffered from methemoglobin level above 2% after prescribing nitroglycerin, and the only predictor of abnormal methemoglobin level was the rate of nitroglycerin prescription. Anesthesiologists are recommended to be more careful about the speed of nitroglycerin infusion, and if the patient needs higher doses, patient care for the early detection of methemoglobinemia should be the priority.

show abstract

Intravenous indoxacarb toxicity: A rare case of unusual exposure with clinical implications

Rad,

Shahrokhi,

Mashayekhi-sardoo

et al. 2025

Toxicology Reports

View full text Add to dashboard Cite

Management of indoxacarb poisoning in a regional setting

Cited by 4 publications

References 5 publications

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

Prevalence of Abnormal Methemoglobinemia and Its Determinants in Patients Receiving Nitroglycerin During Anesthesia

Intravenous indoxacarb toxicity: A rare case of unusual exposure with clinical implications

Contact Info

Product

Resources

About