What are the initial priorities in managing a patient presenting with active seizures? AnswerWhen a patient comes with a seizure, initial attention, as always, should be given to the airway, breathing, and circulation, along with attempts to immediately control seizures. Airway management includes assessment of the airway for potential obstruction, aspiration, and protecting the airway with lateral decubitus position, suctioning of secretion, and securing the airway with intubation if it is threatened. Rapid sequence intubation should be the standard of care for airway intubation, with a more experienced airway manager performing the intubation. Care should be taken to prevent hemodynamic instability during intubation, with efforts to optimize, preload, and use vasopressors. Control of seizures and evaluation for the same should occur simultaneously. Prompt cessation of seizures is very important and should be achieved as early as possible since seizures tend to become refractory and lead to long-term adverse neurological Case DisCussion Case DescriptionA 39-year-old female with no past medical history presented elsewhere following a generalized tonic-clonic seizure on her 35th week of gestation. She was G2P1L1A1, and her antepartum period was complicated by hypothyroidism and gestational diabetes. There was no other significant obstetric history.
CASE REPORTand the lack of a specific antidote. Furthermore, neonicotinoid poisoning is often mistaken to be organophosphorus poisoning due to fewer clinical experiences with these compounds, thereby leading to diagnostic confusion and hurdles in management. We hereby report a case of imidacloprid poisoning, which was initially mistaken and treated on the lines of OPC poisoning, creating a clinical dilemma and hampering the management. IntroductIonAccidental self-poisoning with insecticides is a major public health hazard worldwide. OPC account for a major proportion of such cases in developing countries like India. 1 Since the usage of OPC has led to an increased incidence of poisoning with a high mortality rate, compounds considered to be safer alternatives were introduced for that purpose. Neonicotinoid compounds like imidacloprid are one such commercially available alternative. Imidacloprid [1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine] belong to the class of chloronicotinyl nitroguanidine compounds and are classified as moderately toxic by the World Health Organization (WHO). 2 They act on postsynaptic nicotinic acetylcholine receptors and are specific to receptors in insects. This attribute is responsible for its high insecticidal potency and low mammalian toxicity. 3 The use of imidacloprid has been rising in recent years owing to its favorable safety profile and lower mortality rates compared to its older counterparts. However, severe poisoning with adverse outcomes, including fatality, has been reported with these compounds also. 4 This could be attributable to a relatively lesser knowledge pertaining to their toxicological profile in humans
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