title: Successful treatment of methemoglobinemia and acute renal failure after indoxacarb poisoning.
abstract: BACKGROUND
  We report a case of systemic toxicity induced by indoxacarb, an oxadiazine insecticide. Previous reports have suggested the occurrence of methemoglobinemia after indoxacarb ingestion, but no case of indoxacarb-induced systemic toxicity, such as acute renal failure, has been reported thus far.
  
  
  METHODS
  A 71-year-old woman presented with indoxacarb poisoning, resulting in methemoglobinemia and acute renal failure. The methemoglobinemia improved after methylene blue administration, but rapidly progressive acute renal failure occurred 7 h after admission. She was treated with continuous veno-venous hemofiltration and intravenous sodium bicarbonate and recovered successfully.
  
  
  CONCLUSIONS
  Ingestion of indoxacarb may produce not only methemoglobinemia, but also systemic toxicities like acute renal failure, which can be successfully treated with aggressive therapy such as continuous veno-venous hemofiltration. Physicians should be alert to acute renal failure as a possible complication of indoxacarb ingestion, and treat it accordingly.
authors.affiliation: Department of Emergency Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Park
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.forename: Suk Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Min
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D000368:Aged; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007275:Injections, Intravenous; D007306:Insecticides / Q000506:poisoning*; D008708:Methemoglobinemia / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D010078:Oxazines / Q000506:poisoning*; D011041:Poisoning / Q000628:therapy; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D007306:Insecticides; D010078:Oxazines; C401104:indoxacarb; D017693:Sodium Bicarbonate