title: Permethrin emulsion ingestion: clinical manifestations and clearance of isomers.
abstract: BACKGROUND
  Oral intoxication with permethrin, an insecticide which prolongs axonal sodium channel depolarization, has not been documented in humans. We treated a 59-year-old man who drank approximately 600 mL of 20% permethrin emulsion in a suicide attempt.
  
  
  METHODS
  Sequential blood samples were obtained to determine permethrin isomer levels using high-performance liquid chromatography.
  
  
  RESULTS
  Vomiting and diarrhea occurred after ingestion. On admission, loss of consciousness and metabolic acidosis were observed. On regaining consciousness, the patient complained of a burning sensation in the oral cavity. He received fluid therapy after gastric lavage and recovered without severe complications. Apart from initially impaired consciousness, no clinical neurotoxicity such as tremor, hyperexcitation, ataxia, convulsions, or paralysis occurred, though these have been reported in permethrin-intoxicated animals. Serum permethrin concentrations peaked 3-4 hours after ingestion at 868 ng/mL. Clearance of trans permethrin was more rapid than that of cis permethrin.
  
  
  CONCLUSIONS
  The unequal clearance of permethrin isomers paralleled findings in animal experiments. Vomiting and diarrhea probably limited absorption in the present case, resulting in a peak serum concentration and a degree of neurotoxicity far less than those seen in animals.
authors.affiliation: National Defense Medical College Hospital, Tokorozawa, Saitama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Gotoh
authors.forename: M
authors.initials: M
authors.lastname: Kawakami
authors.forename: N
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000284:Administration, Oral; D000818:Animals; D019540:Area Under Curve; D002851:Chromatography, High Pressure Liquid; D004655:Emulsions; D015600:Glasgow Coma Scale; D006801:Humans; D007306:Insecticides / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D026023:Permethrin; D011722:Pyrethrins / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D013237:Stereoisomerism; D013406:Suicide, Attempted
chemical_list: D004655:Emulsions; D007306:Insecticides; D011722:Pyrethrins; D026023:Permethrin