Correspondence

Kumar, K. Jagadish; Nayana, Nayana; Harish, Rekha; Jamwal, Ashu; Babu, Thirunavukkarasu Arun; Chandrasekaran, Venkatesh; Sardana, Sarita; Narain, Raj; Marwaha, R. K.; Kulkarni, Ketan; Yadav, Satya Prakash; Kharya, Gaurav

doi:10.1007/s13312-011-0001-5

Cited by 4 publications

(5 citation statements)

References 4 publications

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“…However, none of the patients had new-onset diabetes mellitus and the pre–hospital discharge blood sugars were in the normal range. Conversely [24-26], organophosphate intoxication presenting as diabetic ketoacidosis has been repeatedly reported in the pediatric population. Using data from the Agricultural Health Study, Saldana et al [7] found that activities involving exposure to agricultural pesticides during the first trimester of pregnancy might increase the risk of gestational diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus

et al. 2014

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BackgroundWe investigated the mortality rates of patients with and without diabetes mellitus after acute large-dose exposure to organophosphate insecticides. All patients without diabetes mellitus were traced to examine the long-term risk of new-onset diabetes mellitus. Previous reports indicated that organophosphate exposure might increase the risk of new-onset diabetes mellitus.MethodsWe analyzed the records of 118 patients referred to Chang Gung Memorial Hospital for management of intentional organophosphate poisoning between 2000 and 2011. Patients were stratified by diabetes mellitus status. Demographic, clinical, laboratory and mortality data were analyzed.ResultsMost patients were middle aged (53.45 ± 16.20 years) and male (65.3%) and were referred to our hospital after a relatively short amount of time had elapsed since poisoning (median 3.0 hours). 18 (15.2%) of 118 patients died, including 15 (13.8%) of 109 patients without diabetes mellitus and 3 (33.3%) of 9 with diabetes mellitus. There was no significant difference in mortality between these groups (P = 0.117). In a multivariate Cox regression model, hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and corrected QT interval prolongation (P = 0.002) were significant risk factors for mortality. Conversely, diabetes mellitus status was not a significant variable in this model. At routine outpatient follow up a median of 1.25 months post exposure, random blood glucose measurements gave no evidence of new-onset diabetes in patients without pre-existing diabetes.ConclusionsDiabetes mellitus status might not increase mortality risk following acute large-dose exposure to organophosphates, and the risk of new-onset diabetes mellitus also might be minimal in the short term. Larger prospective studies with formal testing for diabetes at later times post-exposure are required.

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Section: Discussionmentioning

confidence: 99%

Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus

et al. 2014

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“…There is, worryingly, a growing body of data linking pesticide exposure and diabetes in humans as well (3,4). OP poisoning may also rarely masquerade as diabetic ketoacidosis (5) with the potential for erroneous treatment.…”

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confidence: 99%

Diabetic Ketoacidosis: An Uncommon Manifestation of Pesticide Poisoning

et al. 2012

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“…The OP poisoning was the cause of the coma, hyperglycemia, glycosuria and keto-acidosis in a 3-year-old boy who was in contact with parathion [10]. OP intoxication can mimic diabetic ketoacidosis and its diagnosis may be delayed [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Organophosphates (OP) can influence body glucose homeostasis through several mechanisms including physiological stress, oxidative stress, inhibition of paraoxonase, nitrosative stress, pancreatitis, inhibition of cholinesterase, stimulation of the adrenal gland, and disturbance in the metabolism of liver tryptophan [3]. However, few studies have reported diabetic ketoacidosis with pesticide poisoning [4]. These cases have been reported in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report

Badrane¹,

Askour²,

Berechid³

et al. 2014

BMC Res Notes

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BackgroundThe widespread use of pesticides in public health protection and agricultural pest control has caused severe environmental pollution and health hazards, especially in developing countries, including cases of severe acute and chronic human poisoning. Diabetic ketoacidosis is an uncommon manifestation of acute pesticide poisoning. Suicidal pesticide poisoning by injection is also an unusual way to take poison. We report a severe pesticide mixture poisoning case with diabetic ketoacidosis in an adult with improved outcome after supportive treatment and large doses of atropine.Case presentationA 30-year-old unmarried Moroccan Arab male with a previous history of active polysubstance abuse and behavior disorders had ingested and self injected intravenously into his forearm an unknown amount of a mixture of chlorpyrifos and cypermethrin. He developed muscarinic and nicotinic symptoms with hypothermia, inflammation in the site of the pesticide injection without necrosis. Red blood cell cholinesterase and plasma cholinesterase were very low (<10%). By day 3, the patient developed stroke with hypotension (80/50 mmHg) and tachycardia (143 pulses /min). Laboratory tests showed severe hyperglycemia (4.49 g/dL), hypokaliemia (2.4 mEq/L), glycosuria, ketonuria and low bicarbonate levels (12 mEq/L) with improvement after intensive medical treatment and treatment by atropine.ConclusionSuicidal poisonings with self-injection of insecticide were rarely reported but could be associated with severe local and systemic complications. The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis.

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Correspondence

Cited by 4 publications

References 4 publications

Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus

Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus

Diabetic Ketoacidosis: An Uncommon Manifestation of Pesticide Poisoning

Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report

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