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.
Highlights
The 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
The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis
OP and pyrethroid (PYR) mixture poisoning was assumed on the basis of the medical interview, the compound identification made based on the container brought by the patient’s relatives, cholinergic syndrome associated with pyrethroid effects, tremor and excessive salivation supported by low plasma and red cell cholinesterase levels
Summary
This is the first case of diabetic ketoacidosis caused by pesticide poisoning reported in adults. Establishing the diagnosis of complications of pesticides poisoning is very important for adequate treatment and to improve the patient’s outcome. Consent Written informed consent was obtained from the patient for publication of this Case Report. Competing interests The authors declare that they have no competing interests. Authors’ contributions NB, TD, KB, KA, MA, AAZ handled the case in the MICU. NB, TD, KA, KB, AAZ conceived the case report, and participated in its design. NB, TD, AAZ drafted the manuscript and sequence alignment of the report. NB, KB, MA, AAZ reviewed the literature. All authors read and approved the final manuscript. Author details 1Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Morocco. Author details 1Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Morocco. 2Service de Réanimation Médicale-CHU Ibn Sina, Rabat-Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V Souissi, Rabat, Morocco
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