title: Cardiac conduction disturbance due to prallethrin (pyrethroid) poisoning.
abstract: Pyrethroids are common household insecticides. Even though they are less toxic to humans, reports of accidental and suicidal poisoning are not uncommon. Cardiotoxicity due to pyrethroid poisoning is rare. We report a case of cardiac conduction disturbance due to a pyrethroid, prallethrin. A 28-year-old female presented after a suicidal consumption of prallethrin. Her clinical and laboratory parameters were normal during the first 24 h of hospital stay. On the second hospital day, she developed metabolic acidosis and sinus arrest with escape junctional rhythm. Despite correction of metabolic acidosis, the sinus arrest persisted for 3 days. She reverted back to sinus rhythm with bradycardia after this period and was discharged on the seventh hospital day. Her follow-up was uneventful. Pyrethroid poisoning can affect the gastrointestinal, respiratory, and nervous system. Most serious effects of the toxin in humans are seizures and coma. Mechanism of pyrethroid neurotoxicity is believed to be due to its ability to modify sodium, chloride, and calcium channels of the neurons. Our case raises the possibility that cardiac arrhythmia due to pyrethroid poisoning can occur due to its effect on sodium channels in the heart.
authors.affiliation: Department of Medicine, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India PIN-600116. drmebchennai@rediffmail.com
authors.forename: Emmanuel M
authors.initials: EM
authors.lastname: Bhaskar
authors.forename: Swathy
authors.initials: S
authors.lastname: Moorthy
authors.forename: Gaurav
authors.initials: G
authors.lastname: Ganeshwala
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
mesh_terms: D000138:Acidosis / Q000139:chemically induced; D000328:Adult; D001919:Bradycardia / Q000139:chemically induced* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D011722:Pyrethrins / Q000506:poisoning*; D054138:Sinus Arrest, Cardiac / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D015222:Sodium Channels / Q000187:drug effects / Q000378:metabolism; D013406:Suicide, Attempted; D013997:Time Factors
chemical_list: D007306:Insecticides; D011722:Pyrethrins; D015222:Sodium Channels; C055818:d,d-T80-prallethrin