Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Toxicol (Phila). 2024 May;62(5):329-333. doi: 10.1080/15563650.2024.2350606. Epub 2024 Jun 10.
Tolfenpyrad, a novel insecticide originating from Japan and first approved in 2002, has been marketed in numerous countries. Data on tolfenpyrad exposure in humans are limited. This study aimed to characterize the clinical features and outcomes of acute poisoning from tolfenpyrad-based insecticides in Thailand.
This retrospective study analyzed cases of tolfenpyrad exposure reported to the Ramathibodi Poison Center from 2012 to 2022.
A total of seven patients were identified, with the majority being male ( = 5). Deliberate tolfenpyrad exposure accounted for three cases. The median age was 33 (range 1-46) years. Severe systemic effects were evident at presentation in the four patients ingesting tolfenpyrad. These included altered mental status ( = 4), mydriasis ( = 2), cardiac arrest ( = 1), hypotension ( = 4), bradycardia ( = 2), and high anion gap metabolic acidosis ( = 4). The median time from exposure to hospital presentation was 30 (range 15-60) minutes. All four patients ingesting tolfenpyrad died, whereas the three patients exposed via inhalation and dermally developed only mild clinical effects, and all were discharged following supportive care.
We observed many of the clinical features reported previously, including vomiting, mydriasis, altered mental status, metabolic acidosis, and hypotension. We also noted a combination of bradycardia and hypotension while not observing respiratory depression.
Tolfenpyrad insecticide poisoning has been reported infrequently. Rapid systemic toxicity can follow ingestion, resulting in a high mortality. Larger-scale studies are essential to identify predictors of severity and determine the optimal treatment for tolfenpyrad-poisoned patients.
托芬pyrad 是一种源自日本的新型杀虫剂，于 2002 年首次获得批准，已在许多国家销售。有关人类接触托芬pyrad 的数据有限。本研究旨在描述泰国托芬pyrad 基杀虫剂急性中毒的临床特征和结局。
本回顾性研究分析了 2012 年至 2022 年向 Ramathibodi 中毒中心报告的托芬pyrad 暴露病例。
共确定了 7 例患者，大多数为男性（5 例）。有 3 例为故意托芬pyrad 暴露。中位年龄为 33 岁（范围 1-46 岁）。摄入托芬pyrad 的 4 例患者在就诊时表现出严重的全身效应，包括意识改变（4 例）、瞳孔散大（2 例）、心脏骤停（1 例）、低血压（4 例）、心动过缓（2 例）和阴离子间隙代谢性酸中毒（4 例）。从暴露到就诊的中位时间为 30 分钟（范围 15-60 分钟）。摄入托芬pyrad 的 4 例患者全部死亡，而通过吸入和皮肤暴露的 3 例患者仅出现轻度临床症状，均在接受支持性治疗后出院。
我们观察到了许多先前报道的临床特征，包括呕吐、瞳孔散大、意识改变、代谢性酸中毒和低血压。我们还注意到心动过缓和低血压的组合，而没有观察到呼吸抑制。
托芬pyrad 杀虫剂中毒的报道很少。摄入后可迅速发生全身毒性，导致高死亡率。需要更大规模的研究来确定严重程度的预测因素，并确定托芬pyrad 中毒患者的最佳治疗方法。
