PLA patients with and without DM have different clinical characteristics, but DM is not a predictor of fatality. We have identified several biomarkers that might help reduce the misdiagnosis of PLA.

Neonicotinoids are a new class of insecticides widely applied for crop protection. These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death. The high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. We reported a man who developed respiratory failure and shock after ingestion of neonicotinoid insecticide. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. The amounts of ingested neonicotinoid insecticide and the plasma neonicotinoid concentration are not useful guides for the management of intoxicated patients. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients.Neonicotinoids, a new class of insecticide, are effective for crop protection and flea control. The insecticides act as agonists at nicotinic acetylcholine receptors and cause insect paralysis and death [1,2]. The high specificity for receptors in insect contributes to their selective toxicity to insects and relative sparing of mammals [1]. The relatively low risk for nontarget organisms and the environment, the high specificity for target insects and the versatility in application methods have made neonicotinoids popular insecticides in recent years [1][2][3]. Accordingly, the number of cases with acute neonicotinoid poisoning also has dramatically increased in Taiwan [4]. The mortality rates of neonicotinoid poisoning in two large studies were 0-2.9%, which is much lower than that of other insecticides [4,5]. However, severe intoxication and even death after exposure to neonicotinoid were reported [4][5][6][7][8][9][10][11][12][13][14]. The exact mechanisms of neonicotinoid poisoning are still unknown, and physicians are unaware of the warning signs that could indicate the development of severe morbidity or poor outcome. Herein, we presented a patient with neonicotinoid poisoning from suicide attempt and reviewed the literature for better understanding the clinical features and management. Case ReportA 56-year-old man with a history of depression was treated in a psychiatric clinic regularly for 20 years. His wife found him attempting to commit suicide by ingesting approximately 40 ml of pesticide 20 min. before his arrival at the emergency department; he retched and vomited persistently. The pesticide was Tie-Sha-Zhang, which contains 9.6% imidacloprid in the solvent N-methyl-2-pyrrolidone. At the time of arrival, his vital signs were as follows: body temperature, 36°C; pulse, 79 beats/min.; respiratory rate, 24/min.; and blood pressure, 87/ 56 mmHg. A physical examination revealed a drowsy man with dyspnoea, diaphoresis, drooling and multiple oral ulcers. Laboratory investigations demonstrated a white cell count of 1...

CT evidence of FI is a good indicator of hypovolemia and an accurate predictor for prognosis in trauma patients with blunt solid organ injuries.