Amitraz is commonly used in agricultural industries throughout the world as a farm-animal insecticide. Despite its widespread use, amitraz intoxication is extremely rare and mainly occurs through accidental ingestion by young children. Severe, life-threatening amitraz intoxication in adults is very rarely recognized and reported. Described herein is a previously healthy 54-year-old patient who accidentally ingested a mouthful of liquid amitraz concentrate, and rapidly developed life-threatening clonidine-like overdose syndrome, manifested as nausea, vomiting, hypotension, bradycardia, bradypnoea, and deep coma. Supportive treatment, including mechanical ventilation, and atropine administration resulted in full recovery within 48 hr. Very few cases of near-fatal amitraz poisoning in adults have been described in the medical literature, leading to low awareness of physicians in general practice to the potential toxicity of amitraz. As a consequence, cases of amitraz poisoning are not recognised and therefore erroneously treated as the much more commonly recognized organophosphate and carbamate intoxication. In our discussion, we review the clinical and laboratory manifestations of amitraz poisoning, including clinical hints that aid in the recognition of this often-overlooked diagnosis. Differentiation of amitraz intoxication from the much more commonly seen pesticide-related organophosphate and carbamate intoxication is of utmost importance, in order to avoid erroneous, unnecessary, and often dangerous treatment.Amitraz is a commonly used pesticide, employed by farmers throughout the world for the treatment of insect infestation in farm animals. It is usually provided in highly concentrated liquid solutions (usually containing xylene as a solvent), while its preparation in agricultural use requires dilution in 1:500 to 1:1000 ratios. Ingestion of small quantities of amitraz is associated with self-limiting nausea and vomiting, while ingestion of larger quantities may result in clonidine-like overdose syndrome. Herein, we report a patient who, upon consumption of a small quantity of amitraz concentrate, developed a severe clonidine-like overdose syndrome associated with life-threatening coma.
Materials and MethodsA 54-year-old male farmer was referred from a rural hospital to our Emergency Services, for evaluation and treatment of presumed organophosphate poisoning. The patient had ingested a mouthful (estimated 20-30 cc) of liquid pesticide, which he erroneously thought was juice. After 30 min. he developed nausea and vomiting. While being transferred to our medical center, he became progressively bradycardic, bradypnoeic, and had a declining mental status. No convulsions were noted. His medical history was unremarkable, with no medical conditions and no history of alcohol and drug abuse. The patient strongly denied consumption of any medication, including over-the-counter, natural and alternative drugs. No atherosclerotic, hypercoagulable, or bleeding tendencies were noted.On admission the patient appe...