Near‐Fatal Amitraz Intoxication: The Overlooked Pesticide

Abstract

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...

A near-fatal case of acute poisoning by amitraz/xylene showing atrial fibrillation

“…Recently, some reports on amitraz/xylene poisoning in adults have appeared [8,[10][11][12][13][14]. The typical symptoms of amitraz as an α 2 -adrenoreceptor agonist are considered to be miosis, hyperglycemia, hypotension, and bradycardia; those due to xylene are depression, ataxia, stupor, and coma [15].…”

Amitraz: a mimicker of organophosphate poisoning

“…However, awareness about this compound and its toxicity remains poor among clinicians 5. Amitraz poisoning is often misdiagnosed as organophosphate/carbamate (OPC) poisoning, since it manifests with several clinical features (miosis, bradycardia and hypotension) observed with OPC poisoning; organophosphate/carbamates are more widely available compounds and universally known to emergency physicians 5 6. We present a case of a young patient who developed amitraz intoxication after suicidal ingestion and was initially misdiagnosed with OPC poisoning.…”

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

“…It stimulates α2 receptors in the CNS, α2 and α1 receptors in the periphery [15] and also inhibits monoamine oxidase (MAO) enzyme activity and prostaglandin E2 synthesis [3, 16, 17]. The effects of amitraz in animals resemble that of pure alpha 2-adrenergic agonist drugs like clonidine [3, 4, 12, 18]. It can also be misdiagnosed as organophosphate or carbamate toxicity, since all three share several similar clinical features [19].…”