title: Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning.
abstract: BACKGROUND
  Neonicotinoids are a relatively new class of insecticides. They exhibit agonistic effects at postsynaptic nicotinic receptors in insects and are believed to have low toxicity in humans.
  
  
  METHODS
  We conducted a retrospective analysis of all neonicotinoid exposures reported to the Taiwan National Poison Center to better understand the toxicity profile of neonicotinoid insecticides.
  
  
  RESULTS
  A total of 70 patients were analyzed. Most exposures involved suicidal ingestions of imidacloprid alone. Clinical manifestations of neonicotinoid insecticide toxicity bear some resemblance to those of acute nicotine poisoning. Although most exposures were of mild-to-moderate severity, eight patients developed major effects and two died. Aspiration pneumonia and respiratory failure were the main cause of severe toxicity.
  
  
  CONCLUSIONS
  Significant toxicity of neonicotinoids can occur following large amount of oral ingestion. Poisoned patients may present with cholinergic syndrome, and judicious use of atropine seems justified. Symptomatic treatment, especially ventilator support, remains most important in clinical management.
authors.affiliation: Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Dong Haur
authors.initials: DH
authors.lastname: Phua
authors.forename: Chun Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Ming-Ling
authors.initials: ML
authors.lastname: Wu
authors.forename: Jou-Fang
authors.initials: JF
authors.lastname: Deng
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000931:Antidotes / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000506:poisoning; D007223:Infant; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D000073943:Neonicotinoids; D018722:Nicotinic Agonists / Q000506:poisoning*; D009574:Nitro Compounds / Q000506:poisoning; D011015:Pneumonia, Aspiration / Q000139:chemically induced; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011978:Receptors, Nicotinic / Q000187:drug effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013577:Syndrome; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000931:Antidotes; D007093:Imidazoles; D007306:Insecticides; D000073943:Neonicotinoids; D018722:Nicotinic Agonists; D009574:Nitro Compounds; D011978:Receptors, Nicotinic; C082359:imidacloprid; D001285:Atropine