title: Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report.
abstract: BACKGROUND
  The widespread use of pesticides in public health protection and agricultural pest control has caused severe environmental pollution and health hazards, especially in developing countries, including cases of severe acute and chronic human poisoning. Diabetic ketoacidosis is an uncommon manifestation of acute pesticide poisoning. Suicidal pesticide poisoning by injection is also an unusual way to take poison. We report a severe pesticide mixture poisoning case with diabetic ketoacidosis in an adult with improved outcome after supportive treatment and large doses of atropine.
  
  
  METHODS
  A 30-year-old unmarried Moroccan Arab male with a previous history of active polysubstance abuse and behavior disorders had ingested and self injected intravenously into his forearm an unknown amount of a mixture of chlorpyrifos and cypermethrin. He developed muscarinic and nicotinic symptoms with hypothermia, inflammation in the site of the pesticide injection without necrosis. Red blood cell cholinesterase and plasma cholinesterase were very low (<10%). By day 3, the patient developed stroke with hypotension (80/50 mmHg) and tachycardia (143 pulses /min). Laboratory tests showed severe hyperglycemia (4.49 g/dL), hypokaliemia (2.4 mEq/L), glycosuria, ketonuria and low bicarbonate levels (12 mEq/L) with improvement after intensive medical treatment and treatment by atropine.
  
  
  CONCLUSIONS
  Suicidal poisonings with self-injection of insecticide were rarely reported but could be associated with severe local and systemic complications. The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis.
authors: Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Morocco. narjiscap@yahoo.fr.
authors: Narjis
authors: N
authors: Badrane
authors: Majda
authors: M
authors: Askour
authors: Kamal
authors: K
authors: Berechid
authors: Khalid
authors: K
authors: Abidi
authors: Tarek
authors: T
authors: Dendane
authors: Amine Ali
authors: AA
authors: Zeggwagh
mesh_terms: D000284:Administration, Oral; D000328:Adult; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007275:Injections, Intravenous; D007306:Insecticides / Q000008:administration & dosage / Q000506:poisoning*; D008297:Male; D062025:Organophosphate Poisoning / Q000150:complications* / Q000188:drug therapy
chemical_list: D007306:Insecticides