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KMID : 0385920120230050750
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Journal of the Korean Society of Emergency Medicine
2012 Volume.23 No. 5 p.750 ~ p.752
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Methemoglobinemia and Seizure Following Indoxacarb Poisoning
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Oh Young-Min
Choi Kyoung-Ho
Lee Kyoung-Uk
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Abstract
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Indoxacarb is an oxadiazine insecticide with selective lethality through blockade of neuronal voltage-dependent sodium channels. It has a low mammalian toxicity, and few cases of human toxicity after indoxacarb ingestion can be found in the literature. A 36 year-old male patient visited our ED after a generalized tonic clonic seizure, which was witnessed by his mother. His past medical history was nonspecific. On initial presentation, he showed a decreased level of consciousness with a Glasgow coma score of 5/15 (E1V1M3), unprotected airway, hypoxia, and cyanosis. The saturation gap and cyanosis after intubation and mechanical ventilation was strongly suggestive of methemoglobinemia due to poisoning. Finally, the methemogobin (metHb) level was 27.4%. Therefore, the patient received 100 mg of methylene blue (2 mg/kg, 1% solution) and 50 g of charcoal. The insecticide was found to be ingested xenobiotic (Steward Gold?; 5% indoxacarb; 95% inert ingredients and other components). On the second hospital day, the patient became alert. The patient`s metHb level was 0.1%. The endotracheal tube was removed. On the fifth hospital day, he was discharged in good condition. Herein we present a case of indoxacarb poisoning with methemoglobiemia and seizure, which are unusual presentations.
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KEYWORD
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Indoxacarb, Poisoning, Methemoglobinemia, Seizure
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