Organophosphorus or Imidacloprid Poisoning? A Clinical Conundrum

Abstract

CASE REPORTand the lack of a specific antidote. Furthermore, neonicotinoid poisoning is often mistaken to be organophosphorus poisoning due to fewer clinical experiences with these compounds, thereby leading to diagnostic confusion and hurdles in management. We hereby report a case of imidacloprid poisoning, which was initially mistaken and treated on the lines of OPC poisoning, creating a clinical dilemma and hampering the management. IntroductIonAccidental self-poisoning with insecticides is a major public health hazard worldwide. OPC account for a major proportion of such cases in developing countries like India. 1 Since the usage of OPC has led to an increased incidence of poisoning with a high mortality rate, compounds considered to be safer alternatives were introduced for that purpose. Neonicotinoid compounds like imidacloprid are one such commercially available alternative. Imidacloprid [1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine] belong to the class of chloronicotinyl nitroguanidine compounds and are classified as moderately toxic by the World Health Organization (WHO). 2 They act on postsynaptic nicotinic acetylcholine receptors and are specific to receptors in insects. This attribute is responsible for its high insecticidal potency and low mammalian toxicity. 3 The use of imidacloprid has been rising in recent years owing to its favorable safety profile and lower mortality rates compared to its older counterparts. However, severe poisoning with adverse outcomes, including fatality, has been reported with these compounds also. 4 This could be attributable to a relatively lesser knowledge pertaining to their toxicological profile in humans