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.
Keywords: Pyrethroid poisoning, Prallethrin poisoning, Metabolic acidosis, Sinus arrest
Full Text
The Full Text of this article is available as a PDF (167.0 KB).
Footnotes
No funding was obtained. Case not presented in any conference or submitted for publication elsewhere.
References
- 1.Matsunaga T, Makita TM, Higo A, Nishibe I, Dohara K, Shinjo G. Studies on prallethrin, a new synthetic pyrethroid for indoor applications. I. The insecticidal activities of prallethrin. Jpn J Sanit Zool. 1987;38:219–223. [Google Scholar]
- 2.Bradberry SM, Cage SA, Proudfoot AT, Vale JA. Poisoning due to pyrethroids. Toxicol Rev. 2005;24(2):93–106. doi: 10.2165/00139709-200524020-00003. [DOI] [PubMed] [Google Scholar]
- 3.Safety of pyrethroid for public health use. World Health Organization. Geneva 2005. Available at libdoc.who.int/hq/2005/WHO_CDS_WHOPES_GCDPP_2005.10.pdf. Accessed 17 May 2008
- 4.He F, Wang S, Liu L, Chen S, Zhang Z, Sun J. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol. 1989;63(1):54–58. doi: 10.1007/BF00334635. [DOI] [PubMed] [Google Scholar]
- 5.Chen SY, Zhang ZW, He FS, Yao PP, Wu YQ, Sun JX, Liu LH, Li QG. An epidemiological study on occupational acute pyrethroid poisoning in cotton farmers. British journal of industrial medicine. 1991;48(2):77–81. doi: 10.1136/oem.48.2.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ray David E, Forshaw Philip J. Pyrethroid insecticides: poisoning syndromes, synergies and therapy. Clinical Toxicology. 2000;38(2):95–101. doi: 10.1081/clt-100100922. [DOI] [PubMed] [Google Scholar]
- 7.Yang PY, Lin JL, Hall AH, Tsao TC, Chern MS. Acute ingestion poisoning with insecticide formulations containing the pyrethroid permethrin, xylene, and surfactant: a review of 48 cases. J Toxicol Clin Toxicol. 2002;40(2):107–113. doi: 10.1081/clt-120004397. [DOI] [PubMed] [Google Scholar]
- 8.Prallethrin . WHO specifications and evaluations for public health pesticides. World Health Organization .Geneva 2004. Available at www.who.int/whopes/quality/en/prallethrin_spec_eval_Nov_2004.pdf. Accessed on 17 May 2008
- 9.Forsythe Sean M, Schmidt Gregory A. Sodium bicarbonate for the treatment f lactic acidosis. Chest. 2000;117:260–267. doi: 10.1378/chest.117.1.260. [DOI] [PubMed] [Google Scholar]
- 10.Brucculeri M, Kaplan J, Lande L. Reversal of citalopram-induced junctional bradycardia with intravenous sodium bicarbonate. Pharmacotherapy. 2005;25(1):119–122. doi: 10.1592/phco.25.1.119.55630. [DOI] [PubMed] [Google Scholar]
- 11.Spencer CI, Yuill KH, Borg JJ, Hancox JC, Koslowski RZ. Actions of pyrethroid insecticides on sodium currents, action potentials, and contractile rhythm in isolated mammalian ventricular myocytes and perfused hearts. J Pharmacol Exp Ther. 2001;298:1067–1082. [PubMed] [Google Scholar]