Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report

Abstract

BackgroundThe widespread use of pesticides in public health protection and agricultural pest control has caused severe environmental pollution and health hazards, especially in developing countries, including cases of severe acute and chronic human poisoning. Diabetic ketoacidosis is an uncommon manifestation of acute pesticide poisoning. Suicidal pesticide poisoning by injection is also an unusual way to take poison. We report a severe pesticide mixture poisoning case with diabetic ketoacidosis in an adult with improved outcome after supportive treatment and large doses of atropine.Case presentationA 30-year-old unmarried Moroccan Arab male with a previous history of active polysubstance abuse and behavior disorders had ingested and self injected intravenously into his forearm an unknown amount of a mixture of chlorpyrifos and cypermethrin. He developed muscarinic and nicotinic symptoms with hypothermia, inflammation in the site of the pesticide injection without necrosis. Red blood cell cholinesterase and plasma cholinesterase were very low (<10%). By day 3, the patient developed stroke with hypotension (80/50 mmHg) and tachycardia (143 pulses /min). Laboratory tests showed severe hyperglycemia (4.49 g/dL), hypokaliemia (2.4 mEq/L), glycosuria, ketonuria and low bicarbonate levels (12 mEq/L) with improvement after intensive medical treatment and treatment by atropine.ConclusionSuicidal poisonings with self-injection of insecticide were rarely reported but could be associated with severe local and systemic complications. The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis.

The Subcutaneous Injection of Organophosphate: A Case Report

“…OP might be absorbed by any route, including transdermal, transconjunctival, inhalation, across the GI or genitourinary mucosa, and direct injection [11]. The onset of systemic symptoms may occur in 5 minutes with inhala-tion.…”

Correlation Study Between Erythrocyte Acetylcholinesterase Activity, Serum Malondialdehyde and Insulin Sensitivity in Agricultural Workers and Non-agricultural Workers in Nat-Kan Village, Magway Township

“…Consequently, an increasing awareness of the association between hyperglycemia and organophosphate pesticides in humans was borne out of many studies. 18 , 33 , 34 A longitudinal study done observed the increased risk of diabetes in pesticide applicators who had used OP compounds. 7 Another study noted that 28 out of 102 patients with a history of OP pesticide poisoning had random blood sugar levels >140 mg/dL.…”

Pesticide Mixture Poisoning: A Case Report

“…The Asia-Pacific region witnesses agrochemical poisoning as a leading cause of mortality due to exposure to OP, OC, and aluminum phosphide compounds being an integral part of agriculture and their availability at low cost [6]. Easy [14][15] and OP-pyrethroid mixtures [16][17].…”