title: Severe human poisoning with a flufenoxuron-containing insecticide: Report of a case with transient myocardial dysfunction and review of the literature.
abstract: BACKGROUND
  Flufenoxuron (Cascade™) is a new benzoylurea insecticide. We describe a case of human poisoning with previously unreported cardiac complications and review other case reports in the literature.
  
  
  METHODS
  A 54-year-old stuporous man who had ingested a flufenoxuron-containing insecticide presented to the emergency department with severely unstable vital signs and lactic acidosis which continued to worsen over time. He was treated with gastric lavage and infusion of sodium bicarbonate, crystalloid, and dopamine. The patient was initially unresponsive, but recovered from shock after norepinephrine treatment. While electrocardiography showed no abnormal findings, cardiac enzymes remained elevated for several days. Initial echocardiography showed global left ventricular hypokinesia and a left ventricular ejection fraction of 40%, but echocardiography after 45 h showed normal results. On the sixth day, he was discharged after rejecting medical advice for further evaluation.
  
  
  CONCLUSIONS
  Severe lactic acidosis, shock, elevation of cardiac enzymes, and global left ventricular hypokinesia can occur in human poisoning with flufenoxuron-containing insecticide, and norepinephrine is preferable for the management of shock.
authors.affiliation: Department of Emergency and critical care medicine, Gachon university Gil medical center , Incheon , Republic of Korea.
authors.forename: Jae-Hyug
authors.initials: JH
authors.lastname: Woo
authors.forename: Yong Su
authors.initials: YS
authors.lastname: Lim
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004562:Electrocardiography; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000506:poisoning*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012769:Shock / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D007306:Insecticides; D010671:Phenylurea Compounds; C067660:flufenoxuron; D009638:Norepinephrine
keywords: Cardiac enzymes; Cardiac injury; Flufenoxuron; Hypokinesia; Norepinephrine