An uncommon but lethal poisoning – Amitraz

Chakraborty, Joydeep; Nagri, Shivashankara Kaniyoor; Gupta, Amit; Bansal, Ankush

doi:10.4066/amj.2011.777

Cited by 9 publications

(12 citation statements)

References 7 publications

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“…Miosis with absence of light reflex is also commonly seen [1, 5, 10, 19–21, 24]. Mydriasis has also been described but less commonly [1, 5, 9, 22, 24, 25]. This is because at low doses, α 2 adrenergic agonists induce miosis by its effect on presynaptic receptors and in higher doses cause mydriasis by its action on postsynaptic receptors [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Amitraz poisoning: A case report of an unusual pesticide poisoning in Sri Lanka and literature review

Herath

Pahalagamage

Yogendranathan

et al. 2017

BMC Pharmacol Toxicol

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BackgroundAmitraz is a pesticide used worldwide on animals and in agriculture. It contains triazapentadiene, which is a centrally acting alpha-2 adrenergic agonist. Amitraz poisoning is fairly uncommon in humans and occurs via oral, dermal or inhalational routes. Only a limited number of case reports of human intoxication have been published and most of them are of accidental ingestion by children.Case presentationA twenty-year-old Sri Lankan female presented following self-ingestion of 20 ml of amitraz resulting in 37.8 mg/ kg of amitraz poisoning. She lost consciousness after 20 min of ingestion, developed bradycardia and hypotension, which needed intravenous fluid resuscitation and dobutamine. Gastric lavage was performed. Her bradycardia persisted for 36 h and she was drowsy for 48 h. She did not develop respiratory depression, convulsions or hypothermia and the urine output was normal. Arterial blood gas revealed mild respiratory alkalosis. She recovered fully within 48 h and was discharged on day 3.ConclusionThe clinical manifestations of amitraz (impaired consciousness, drowsiness, vomiting, disorientation, miosis, mydriasis, hypotension, bradycardia, respiratory depression, hypothermia, generalized seizures, hyperglycemia and glycosuria) can be explained by the agonist action of amitraz on α1 and α2 receptors. Management of amitraz poisoning is still considered to be supportive and symptomatic with monitoring of nervous system, cardiovascular and respiratory systems. Activated charcoal may still be considered for treatment and the place for gastric lavage is controversial. Atropine is effective for symptomatic bradycardia and inotropic support is needed for hypotension that does not respond to fluid resuscitation. Diazepam or Lorazepam is used for convulsions and some patients may require intubation and ICU care. Several α2 adrenergic antagonists like yohimbine have been tried on animals, which have successfully reversed the effects of amitraz. Since the majority of amitraz poisoning cases are due to accidental ingestion, manufactures, regulatory authorities and national poisons control centers have a significant role to play in minimizing its occurrence.

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Section: Discussionmentioning

confidence: 99%

Amitraz poisoning: A case report of an unusual pesticide poisoning in Sri Lanka and literature review

Herath

Pahalagamage

Yogendranathan

et al. 2017

BMC Pharmacol Toxicol

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“…Los receptores alfa 2 están ubicados en la región pre-sináptica, son de tipo proteí-na G inhibitoria, por tanto, disminuyen la producción de segundos mensajeros como el AMPc y su acción es simpaticolítica. Por este efecto se explica la disminución de la frecuencia cardiaca, la presión arterial y los sínto-mas neurológicos, aunque hay otras teorías sobre cómo afecta el amitraz al sistema nerviosos central 2,3,11 , como la que tiene en cuenta el desbalance de neurotransmi-…”

Section: Discussionunclassified

“…También se presenta disminución de la liberación de insulina, lo que explica la hiperglicemia, característica de la intoxicación que tiene utilidad en el diagnóstico diferencial. También se evidencia miosis, aunque se reportan casos de midriasis ya que la respuesta de los receptores alfa 2 oculares es dependiente de la dosis 11 . Adicionalmente, el amitraz inhibe el centro respiratorio y ello explica la depresión respiratoria.…”

Section: Declaración De Conflicto De Interesesunclassified

“…Adicionalmente, el amitraz inhibe el centro respiratorio y ello explica la depresión respiratoria. También se ha reportado su capacidad para inhibir la MAO, in vivo, pero no in vitro 11,12 . Se encuentran reportes de casos en los que hay manifestaciones como arritmias de puntas torcidas 13 o síndrome de Ogilvie, un tipo de pseudoparálisis intestinal 14 .…”

Section: Declaración De Conflicto De Interesesunclassified

“…Una ayuda clara cuando se sospecha intoxicación por amitraz es la evidencia de la hiperglicemia. El diagnóstico de la intoxicación por amitraz es clínico, además de los síntomas descritos, son útiles tanto el conocimiento de la ocupación del paciente como el de las características fisicoquímicas de la sustancia (descritas por el paciente o por sus acompañantes) 11 .…”

Section: Declaración De Conflicto De Interesesunclassified

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Reporte de caso de intoxicación por amitraz

Rosas¹,

Mejía²

2017

MedUPB

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RESUMENLa intoxicación por amitraz es poco frecuente en Colombia. Los objetivos de este reporte de caso son evidenciar una presentación atípica de la intoxicación en un paciente de edad avanzada y resaltar aspectos toxico-cinéticos y toxico-dinámicos asociados. La literatura consiste, principalmente, en reportes de caso y series de casos y en Norteamérica. Existe la necesidad de que el personal de salud involucrado en el manejo de estos pacientes reconozca aspectos clave de su fisiopatología y tratamiento. El caso reportado es de un paciente masculino de 73 años, intoxicado por amitraz, que se presenta inicialmente sin alteraciones, y luego de 33 horas, presenta alteraciones del sensorio y compromiso respiratorio, por lo que requiere una disposición en Unidad de Cuidados Especiales (UCE). El paciente tiene evolución satisfactoria. Palabras clave: insecticidas; envenenamiento; fisiopatología. ABSTRACTAmitraz poisoning is not frequent in Colombia. The objectives of this case report are to consider the atypical poisoning in an elderly patient and to emphasize the associated toxic-kinetic and toxic-dynamic aspects. The literature mainly consists of case reports and case series in North America. There is a need for the health personnel involved in the treatment of these patients to recognize key aspects of its physiopathology and treatment. The case reported involves a male patient aged 73 with amitraz poisoning, initially without alterations after 33 hours, presenting sensory alterations and respiratory compromise requiring attention in the Special Care Unit (SCU). The patient recovered satisfactorily. Keywords: insecticides; poisoning; physiopathology. RESUMOA intoxicação por Amitraze é pouco frequente na Colômbia. Os objetivos deste relato de caso são evidenciar uma apresentação atípica da intoxicação num paciente de idade avançada e ressaltar aspectos toxico-cinéticos e toxico-dinâmicos associados. A literatura consiste, principalmente, em relato de caso e séries de casos e na América do Norte. Existe a necessidade de que o pessoal da saúde envolvido no manejo destes pacientes reconheça aspectos chave da sua fisiopatologia e tratamento. O caso reportado é de um paciente masculino de 73 anos, intoxicado por amitraz, que se apresenta inicialmente sem alterações, e logo de 33 horas, apresenta alterações do sensório e compromisso respiratório, pelo qual requere uma disposição em Unidade de Cuidados Especiais (UCE). O paciente tem evolução satisfatória.

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