Poisoning due to pesticides has long been seen as a severe public health problem. A task force of the World Health Organization in early 1990 estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Even after thirty years, there is no clear and accurate picture of global pesticide poisoning despite an increase in pesticide use. Organo phosphates are the major cause of self-poisoning in southern and central India and aluminium phosphide in northern India. Neonicotinoids are a newer class of insecticides with increasing usage in recent decades because of their favourable toxicological profile. Neonicotinoids have a very high margin of safety because of the specificity of the insecticides for nicotinic acetylcholine receptors in insects than mammals combined with rapid metabolism and poor penetration to the blood-brain barrier. The present study was carried out on cases brought for autopsy which revealed Neonicotinoid poisoning. Four cases were studied with the purpose to highlight the toxic effects of a new class of insecticide i.e., neonicotinoids which impose health hazards to humans and animals including death.
Wasp stings usually bring temporary discomfort and pain, but on occasion, they can cause serious infections and fatal allergic reactions. We report on a patient who experienced massive wasp stings and developed multiple organ failures, including acute kidney, hepatic failure, and circulatory collapse. He was treated with aggressive fluid resuscitation, an inotropic agent, an intravenous injection of steroids, broad-spectrum antibiotics, and haemodialysis. After intensive treatment, his liver function recovered one month later. Recovery of renal function was delayed, and the patient needed temporary regular haemodialysis. The patient’s renal and liver parameters were within normal limits in the initial stage after 24 hours his renal and liver parameters were deranged. The patient was immediately started on NAC infusion and emergency dialysis was started. A timely approach by our department saved the life of the patient and after the 8th day patient fully recovered, and he get back to his normal sedentary life. The patient was advised to follow up every week after discharge.
Our quest of exploring nature for manifold reasons has always brought us into conflict with our fellow species on the planet. The stings and bites of aquatic species are sometimes very fatal and if not may also often lead to hazardous late complications. In this case report, we present an instance of a man bitten by a murrel fish, eventual sequelae and management of the same. Moreover, an attempt was also made to discuss the prevention of such complications with respect to bites and stings in general. The purpose of the article is to emphasize about the mechanical trauma/breach of barrier effects of different bites and stings which are often neglected by medical practitioners who are enthusiastic about neutralizing the venom.
Accidental ingestion of commonly available household toxic substances is a leading cause of emergency room visits in pediatric patients because small children have a tendency to put everything in their mouths. Camphor is one such item that is readily available in many Indian homes and is a potentially toxic compound that is not very well-recognized but can cause severe poisoning even consumed in a small amount. We report a case of one and half-year-old male child who presented with seizure after accidental ingestion of camphor.
Haloperidol is a typical antipsychotic drug used in the treatment of schizophrenia and mania in adults, and for hyperactivity, behavioural and movement disorders in children. A common adverse effect of this drug is the development of extrapyramidal symptoms due to the blockage of dopamine receptors. Here we report a case of haloperidol toxicity due to medication error.
Insecticide poisoning in India is a major public health concern. Due to insects' emerging resistance, farmers use newer insecticides and pre-mixed, fixed-dose insecticides. Examples of pre-mixed, fixed-dose insecticides are ethion 40% -cypermethrin 5% combination; chlorpyrifos 50% - cypermethrin 5% combination, trizopas 35% - deltacypermethrin 1% combination, etc. Such pre-fixed combinations are available and sold in India. We report a case series of fatal poisoning by Chlorpyrifos 50% -cypermethrin 5%, a pre-mixed, fixed-dose combination. As per WHO, chlorpyriphos is a class II insecticide and is considered moderately toxic to humans. The LD50 is 135 mg/kg. Cypermethrin is a synthetic pyrethroid class II pesticide with LD 50 of 250mg/kg. The physician should be aware of such pre-mixed combinations and overlapping clinical manifestations produced by these pesticides.
Cases of Paraquat poisoning are on the rise in countries like India, where it is not banned or restricted adequately for use. Paraquat at the molecular level generates oxygen free radicals in the lungs, causing respiratory failure and may also cause acute renal failure in hyper-acute poisoning. There are renal, hepatic and pulmonary manifestations of Paraquat toxicity. We report a case of Paraquat poisoning presenting with toxic hepatitis and multiple fecaliths formations. The clinical toxicologist needs to be wary of bowel-related complications in Paraquat poisoning. The role of paraquat in disturbing bowel mobility and creating a nidus for fecalith formation is of concern in managing the poisoning. Recommendations for proper bowel care in poisoning cases are discussed in this case report.
This study aimed to examine the antioxidants and hepatic enzymes responses of L-arginine on aspartame-induced oxidative stress in 30 male Wistar rats. Aspartame (1000 mg Kg–1 of body weight) was administered by oral intubation daily for 21 days. Aspartame treatment significantly (P < 0.05) increased ferric reducing antioxidant power, total protein, thiobarbituric acid reacting substances, catalase, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase, but decreased superoxide dismutase. Aside from aspartate aminotransferase that was not reduced, L-arginine 20 mg Kg–1was administered alone, and aspartame respectively administered with vitamin C 100 mg Kg–1, L-arginine 20 mg Kg–1 and 40 mg Kg–1, significantly (P < 0.05) decreased ferric reducing antioxidant power, total protein, thiobarbituric acid reacting substances, catalase, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase, but increased superoxide dismutase. These effects induced by aspartame (1000 mg Kg–1) were mitigated by L-arginine irrespective of dose, and in a comparable pattern as a standard antioxidant, vitamin C. Thus, L-arginine significantly mitigated aspartame-induced oxidative stress and impaired hepatic enzymes in the rats. The responses were via probable up-regulated mechanisms in rats' serum antioxidants and hepatic enzymes responses.
In children, acute matchstick head poisoning occurs due to accidental ingestion while playing with match sticks. Toxicity depends on the number of matchstick heads ingested, ranging from less severe GI (gastrointestinal) symptoms to more severe toxic effects like hemolysis, respiratory failure, renal failure, and liver damage.
Neonicotinoids are considered a class of insecticides that are less toxic to human beings than organophosphates, carbamates, pyrethroids and organochlorides. Neonicotinoids are developed and launched in the market in the absence of direct human toxicity data. Human toxicity is extrapolated from animal studies, whose relevance is unclear.Despite its widespread use, very few cases have been reported. We report an unusual case of thiamethoxam poisoning-a 2nd generation neonicotinoid insecticide presenting as methemoglobinemia.
