DELTAMETHRIN POISONING IN A NEONATE: A RARE CASE REPORT
CCCF ePoster library. Desai S. Oct 27, 2015; 117337; P121
Sachin Dattatraya Desai
Sachin Dattatraya Desai
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Abstract
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P121


Topic: Case Report


DELTAMETHRIN POISONING IN A NEONATE: A RARE CASE REPORT



Sachin Desai

Pediatric Critical Care, B C Children Hospital, Vancouver, Canada

Introduction: Deltamethrin is a pyrethroid insecticide. It rapidly paralyses insect nervous system. It is used for protection of field crops. For indoor use, it is used for mosquito, flea, and flies control. It’s a common household item in rural India. Toxicity may happen by ingestion, inhalation or skin contact. Acute toxicity in humans include CNS symptoms like ataxia, convulsions leading to muscle fibrillation and paralysis, dermatitis, edema, diarrhea, dyspnea, hepatic enzyme induction, irritability, vascular collapse, tinnitus, tremors, vomiting, death due to respiratory failure. Oral ingestion causes epigastric pain, nausea, vomiting. With fatal dose, victim may go into coma within 15-20 minutes. There have been reports of dermal poisoning after inappropriate handling of insecticides. There is no specific antidote and management remains supportive.

Objectives: To describe a rare and interesting case of severe deltamethrin poisoning in a neonate with complete recovery.

Methods: A case report

Results: 26 day old baby girl was brought to our hospital emergency in unconscious state with poor respiratory efforts. On further examination, baby had pin point pupils, frothing from mouth and had strange smell. Baby was immediately intubated and transferred to PICU. On further direct questioning, mother admitted that she was cleaning the floor with insecticide containing liquid and immediately fed baby without washing her hands as baby was crying. She mentioned that she touched her breast multiple times while feeding. Post- feeding, baby went to sleep. After 30 minutes, she noted frothing from baby’s mouth and jerky respiration. Baby was immediately rushed to hospital. Parents produced insecticide bottle containing deltamethrin. Management included gastric lavage with normal saline and supportive therapy. After 2-3 hours of admission baby developed hypotension, tachycardia and responded to fluid bolus and inotropic support. Baby also developed abnormal movements with twitching of face, arms, legs and eyes responded to loading phenobarbitone followed by midazolam infusion. EEG was performed which revealed no epileptiform activity. Baby remained on ventilator for 48 hours. Inotrope discontinued after 24 hours. Post extubation, she remained well. As EEG did not reveal any epileptiform activity, phenobarbitone was discontinued. Rest of her blood tests (septic markers, renal function tests, liver function tests) were unremarkable. She was discharged after five days. Child protection team was involved. On follow up at six months, she was growing well without any developmental or neurological concerns.

Conclusion:

We believe this neonate had accidental deltamethrin toxicity from ingestion and may be from dermal absorption during breast feeding although deliberate homicidal intention could not be ruled out. Baby had neurologic and cardiovascular toxicity and respiratory failure. Timely decontamination and supportive therapy (airway control, ventilation, sedation and inotropic support) resulted in a good outcome without any long term adverse effect.



References:
  1. Bradberry SM, Cage SA, Proudfoot AT, Vale JA. Poisoning due to pyrethroids. Toxicol Rev. 2005;24:93–106
  2. Extension Toxicology Network. 1996. Pesticide Information Profile - Deltamithrin. Accessed 14-09-15.
  3. Soderlund DM, Clark JM, Sheets LP, Mullin LS, Piccirillo VJ, Sargent D, et al. Mechanisms of pyrethroid neurotoxicity: Implications for cumulative risk assessment. Toxicology. 2002;171:3–59
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