Agricultural avermectins: an uncommon but potentially fatal cause of pesticide poisoning.
OBJECTIVE
Avermectins have been used in the control of parasites and insects; however, human data concerning poisoning are lacking. This study investigated the clinical spectrum of avermectin poisoning.


METHODS
A retrospective study was conducted to evaluate patients with avermectin poisoning reported to a poison center from September 1993 through December 1997.


RESULTS
Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion were identified. There were 14 male and 5 female patients, ranging in age from 15 to 83 years. Most patients were exposed as a result of attempted suicide (14). Oral ingestion (15) was the most common route of exposure. Four patients were asymptomatic, and 8 had minor symptoms after a mean ingestion of 23 mg/kg abamectin (4.2 to 67 mg/kg), or after dermal and inhalation contact. Seven patients manifested severe symptoms, such as coma (7), aspiration with respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). All 7 patients received intensive supportive care; 1 patient died 18 days later as a result of multiple organ failure.


CONCLUSIONS
Ingestion of a large dose of avermectin may be associated with life-threatening coma, hypotension, and subsequent aspiration.
Chung
K
K
Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taipei, Taiwan.
Yang
C C
CC
Wu
M L
ML
Deng
J F
JF
Tsai
W J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016573:Agrochemicals / Q000506:poisoning*; D003128:Coma / Q000139:chemically induced; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007306:Insecticides / Q000506:poisoning*; D007559:Ivermectin / Q000031:analogs & derivatives* / Q000506:poisoning*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011041:Poisoning / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000706:statistics & numerical data
D016573:Agrochemicals; D007306:Insecticides; C048324:abamectin; D007559:Ivermectin