Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning.
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.
Phua
Dong Haur
DH
Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Lin
Chun Chi
CC
Wu
Ming-Ling
ML
Deng
Jou-Fang
JF
Yang
Chen-Chang
CC
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
D000931:Antidotes; D007093:Imidazoles; D007306:Insecticides; D000073943:Neonicotinoids; D018722:Nicotinic Agonists; D009574:Nitro Compounds; D011978:Receptors, Nicotinic; C082359:imidacloprid; D001285:Atropine