Acute ingestion poisoning with insecticide formulations containing the pyrethroid permethrin, xylene, and surfactant: a review of 48 cases.
BACKGROUND
Forty-eight patients poisoned with insecticide formulations containing permethrin (a Type I pyrethroid insecticide), xylene, and surfactants are reported here. These patients were diagnosed and treated in the Chang Gung Memorial Hospital in Taiwan from January 1987 to June 1999. Ten patients ingested permethrin in error and 38 patients attempted suicide. Gastrointestinal tract signs and symptoms were most common (35/48; 73%), and included sore throat, mouth ulcerations, dysphagia, epigastric pain, and vomiting. Pulmonary abnormalities were documented in 29% (14/48) of patients. Aspiration pneumonitis occurred in eight patients, including onefatal case. Pulmonary edema was observed in two patients. Sixteen patients (33%) had central nervous system involvement including confusion (6/48; 13%), coma (10/48; 21%), and seizures (4/48; 8%). Cardiovascular symptoms in 3/48 (7%) patients were limited to arrhythmias and shock. Mild renal and hepatic dysfunction was found in 5/48 (10%) and 3/48 (6%) of patients, respectively. Leukocytosis occurred in 16 patients (33%) but was not associated with infection. Only one death occurred during this 12.5-year period.


CONCLUSIONS
Poisoning caused by ingesting insecticides containing permethrin, xylene, and surfactant manifests primarily gastrointestinal tract symptoms and signs. The involvement of the central nervous system and lungs were less common, but clinically more significant. The relative contributions of the 20% permethrin, 70% xylene, and 10% surfactant to these toxic manifestations, however, is uncharacterized.
Poison Center and Department of Internal Medicine, Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Po-Yi
PY
Yang
Ja-Liang
JL
Lin
Alan H
AH
Hall
Thomas C Y
TC
Tsao
Ming-Shyan
MS
Chern
D000328:Adult; D000368:Aged; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D008171:Lung Diseases / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D026023:Permethrin / Q000506:poisoning*; D012720:Severity of Illness Index; D013406:Suicide, Attempted; D013501:Surface-Active Agents / Q000506:poisoning; D013624:Taiwan; D014992:Xylenes / Q000506:poisoning
D007306:Insecticides; D013501:Surface-Active Agents; D014992:Xylenes; D026023:Permethrin