Avsarogullari Levent, Ikizceli Ibrahim, Sungur Murat, Sözüer Erdogan, Akdur Okhan, Yücei Murat
Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey.
Clin Toxicol (Phila). 2006;44(1):19-23. doi: 10.1080/15563650500357545.
Amitraz is a formamidine pesticide widely used in agriculture and veterinary medicine as an insecticide and acaricide. Reports on amitraz poisoning in humans are not as prevalent as those in animals. Of human intoxications in the medical literature, the majority of intoxications are in children. The number of adult intoxications with amitraz is limited.
In this study, we discuss the clinical features, laboratory findings, and management of 23 adults with amitraz poisoning cared for in our center. Data were extracted from the charts retrospectively, and included age, gender, mode of poisoning, initial symptoms, time to appearance of initial symptoms, clinical and laboratory findings, management, and prognosis.
Fourteen of 23 patients were female (61%). Ages ranged from 16 and 78 years (mean 38.6 +/- 19.8 years). Twenty-one patients ingested amitraz orally while one was exposed through skin contact and one probably through skin contact and/or inhalation. Seven patients ingested amitraz with intent to commit suicide and 11 patients accidentally. Vomiting, altered consciousness, and drowsiness were the predominant initial symptoms. Initially, hypotension was present in seven patients (30%), bradycardia in two (8.7%), myosis in six (26%), and mydriasis (without atropine administration) in three (13%). Time to appearance of the initial symptoms ranged from 5 to 120 minutes. Laboratory findings included an initial blood glucose level higher than 120 mg/dL in 62% of patients (mean 191 +/- 70 mg/dL) and elevations in AST levels in four patients (81 +/- 28 U/L) and ALT levels in three (60 +/- 14 U/L). Ten patients had central nervous system depression, which resolved spontaneously. Five patients required mechanical ventilation for respiratory depression (mean duration of mechanical ventilatory support: 50 +/- 16 hours). Six patients were thought to have been poisoned with an organophosphate and three with a carbamate pesticide due to confusing clinical picture; four of these nine patients received pralidoxim.
In spite of a rapidly progressing and life-threatening clinical picture, amitraz intoxication in humans carries a low morbidity and mortality when appropriate supportive treatment is given. No antidote has been developed for use in more serious cases. To prevent accidental ingestions, prominent and clear warning labels should be placed on its containers.
双甲脒是一种甲脒类农药，作为杀虫剂和杀螨剂广泛应用于农业和兽医学领域。关于人类双甲脒中毒的报道不如动物中毒的报道普遍。在医学文献中记载的人类中毒案例中，大多数中毒者为儿童。成人双甲脒中毒的案例数量有限。
在本研究中，我们讨论了在我们中心接受治疗的23例成人双甲脒中毒患者的临床特征、实验室检查结果及治疗情况。数据通过回顾病历提取，包括年龄、性别、中毒方式、初始症状、出现初始症状的时间、临床和实验室检查结果、治疗及预后。
23例患者中14例为女性（61%）。年龄范围为16至78岁（平均38.6±19.8岁）。21例患者口服双甲脒，1例通过皮肤接触中毒，1例可能通过皮肤接触和/或吸入中毒。7例患者故意服用双甲脒自杀，11例为意外中毒。呕吐、意识改变和嗜睡是主要的初始症状。最初，7例患者（30%）出现低血压，2例（8.7%）出现心动过缓，6例（26%）出现瞳孔缩小，3例（13%）出现瞳孔散大（未使用阿托品）。出现初始症状的时间为5至120分钟。实验室检查结果包括62%的患者初始血糖水平高于120mg/dL（平均191±70mg/dL），4例患者AST水平升高（81±28U/L），3例患者ALT水平升高（60±14U/L）。10例患者出现中枢神经系统抑制，均自行缓解。5例患者因呼吸抑制需要机械通气（机械通气支持的平均持续时间：50±16小时）。由于临床表现混淆，9例患者中有6例被认为同时接触了有机磷农药，3例接触了氨基甲酸酯类农药；这9例患者中有4例接受了氯解磷定治疗。
尽管双甲脒中毒会导致病情迅速进展并危及生命，但在给予适当的支持治疗后，人类双甲脒中毒的发病率和死亡率较低。目前尚未开发出用于更严重病例的解毒剂。为防止意外摄入，应在其容器上显著且清晰地张贴警示标签。
