Introduction: Here, we report the successful management of indoxacarb poisoning resulting in methemoglobinemia (MetHb) in a young female. Previously published literature has revealed the pathophysiology and occurrence of MetHb after indoxacarb ingestion requiring high oxygen therapy for treatment.
Case description: A 25-year-old female presented with indoxacarb poisoning, resulting in MetHb. She was managed on room air despite the low saturation shown on pulse oximetry. She also received treatment with methylene blue (MB) and vitamin C. The patient recovered completely and was shifted to the ward.
Conclusion: Through this case report, we want to highlight the lacunae in managing indoxacarb toxicity. We suggest that in-depth knowledge of the pathophysiology of indoxacarb toxicity and clinical observations are quintessential before the initiation/continuation of oxygen therapy in such cases. We also emphasize the importance of detailed history taking before initiating treatment with a drug like MB.
New Pest Management Tools: Integrating Biotech, New Chemistry, and Regulations. A Report on the ESA Section F Symposium held during the ESA National Meeting in Ft. Lauderdale, FL. http://www.entsoc.org/Protected/AMT/AMT28/Text/Other/ConferenceReport.html.
McKinley N, Kijima S, Cook G, Sherrod D. Avaunt (indoxacarb): A new mode of action insecticide for control of several key orchard pests. Proceedings of the 76th Annual Western Orchard Pest and Disease Management Conference 9-11 January 2002 published by Washington State Univ., Pullman, Washington. http://www.entomology.tfrec.wsu.edu/wopdmc/2002PDFs/Rep02%20Chemical%20McKinley.pdf
Barker SJ, Tremper KK, Hyatt J. Effects of methemoglobinemia on pulse oximetry and mixed venous oximetry. Anesthesiology 1989;70(1):112–117. DOI: 10.1097/00000542-198901000-00021
Tandale S, Dave NM, Garasia M. Methemoglobinemia: what the anaesthetist must know. Indian J Anaesth 2013;57(4):427–428. DOI: 10.4103/0019-5049.118525
Rino PB, Scolnik D, Fustiñana A, et al. Ascorbic acid for the treatment of methemoglobinemia: the experience of a large tertiary care pediatric hospital. Am J Ther 2014;21(4):240–243. DOI: 10.1097/MJT.0000000000000028
Ramsay RR, Dunford C, Gillman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO-A) confirms a theoretical prediction. Br J Pharmacol 2007;152(6):946–951. DOI: 10.1038/sj.bjp.0707430
Jin K. Rhabdomyolysis, methemoglobinemia and acute kidney injury after indoxacarb poisoning. Clin Toxicol (Phila) 2012;50(3):227. DOI: 10.3109/15563650.2012.657759