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VOLUME 1 , ISSUE 2 ( September-October, 2022 ) > List of Articles


Organophosphorus or Imidacloprid Poisoning? A Clinical Conundrum

Rajasekar Ramadurai, Santhosh Arulprakasam, Srinivasan Swaminathan

Keywords : Atropine, Imidacloprid poisoning, Organophosphate, Poisoning

Citation Information : Ramadurai R, Arulprakasam S, Swaminathan S. Organophosphorus or Imidacloprid Poisoning? A Clinical Conundrum. 2022; 1 (2):55-57.

DOI: 10.5005/jp-journals-11006-0020

License: CC BY-NC 4.0

Published Online: 04-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: Organophosphorus compounds (OPC) account for a major proportion of poisoning in India, with a high mortality rate. Neonicotinoid compounds like imidacloprid are considered to be safer for humans; however, poisoning of these compounds is a rising trend, and the knowledge regarding the management is sparse. Hereby we report the management of a case of imidacloprid poisoning, which initially presented with OPC-like symptoms. Case description: A 19-year-old male presented with a history of suicidal consumption of unknown insecticide and with complaints of vomiting, abdominal pain, and drowsiness. Owing to the presumptive diagnosis of OPC poisoning, atropine and pralidoxime were given in a rural health center and referred to our institute. On presentation, his vitals were stable. With no signs of OPC poisoning noted, on further probing, the bystanders had revealed a container of imidacloprid, and hence the diagnosis was made. Since there is no specific antidote, he was managed conservatively. On the next day, he developed breathlessness, altered sensorium with neck flop, and hence intubated in view of impending respiratory failure. He was evaluated for systemic manifestations of imidacloprid. He was continuously agitated, previously attributed to atropine delirium but now suspected due to neurological manifestation of the poisoning. Also, he has ongoing rhabdomyolysis; hence renal protective measures were done. Eventually, the systemic manifestations subsided, and the patient improved and was weaned off ventilatory support after a week. He was hence discharged after psychiatric consultation and follow-up. Discussion: OPC poisoning is the most common cause of poisoning in India; newer neonicotinoid compounds like imidacloprid have been used. Occasionally, the presence of OPC along with neonicotinoids in commercially available formulations leads to the manifestations of both compounds and hamper the clinical presentation of the other compound leading to misjudgment and hence uncertainty in treatment. The use of antidotes like atropine and pralidoxime will alleviate the muscarinic symptoms. But oximes aggravate the nicotinic effects in the absence of OPC. Since we faced a similar clinical scenario, there was a clinical conundrum. Vigilant monitoring for multi-organ involvement is necessary in such cases. Conclusion: Timely diagnosis, monitoring for clinical effects and complications, and adequate supportive measures and interventions form the core of the management of imidacloprid poisoning.

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