Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE S4 ( December, 2019 ) > List of Articles

INVITED ARTICLE

Pyrethroid Poisoning

Atul M Ramchandra, Peter J Victor

Keywords : Insecticides, Poisoning, Pyrethroid

Citation Information : Ramchandra AM, Victor PJ. Pyrethroid Poisoning. Indian J Crit Care Med 2019; 23 (S4).

DOI: 10.5005/jp-journals-10071-23304

License: CC BY-NC 4.0

Published Online: 01-08-2015

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: Pyrethroid compounds are widely used as insecticides. These compounds not only have a versatile application, but also have favourable toxicological profiles with high selectivity and toxicity to insects and low toxicity to humans. Despite this, there have been several reports of toxicity to humans in both occupational exposure and deliberate ingestional poisoning. Classical presentation and treatment: Two classical syndromic presentations are described. Type I syndrome is characterised predominantly by tremors and is seen with exposure to type I pyrethroids. Type II pyrethroids, which are structurally modified type I pyrethroids with the addition of a cyano group, can result in type II syndrome characterized by choreo-athetosis and salivation. Mega-dose poisoning and mixed poisoning, particularly with organophosphorus compounds, is associated with significant toxicity and death. Treatment is supportive and symptomatic. A favourable outcome can be expected in most patients.


HTML PDF Share
  1. Thatheyus A, Selvam G, Alexander D. Synthetic pyrethroids: toxicity and biodegradation. Appl Ecol Environ Sci 2013;1(3):33–36. DOI: 10.12691/aees-1-3-2.
  2. Ray DE, Forshaw PJ. Pyrethroid insecticides: poisoning syndromes, synergies, and therapy. J Toxicol Clin Toxicol 2000;38(2):95–101. DOI: 10.1081/clt-100100922.
  3. Bradberry SM, Cage SA, Proudfoot AT, Vale JA. Poisoning due to pyrethroids. Toxicol Rev 2005;24(2):93–106. DOI: 10.2165/00139709-200524020-00003.
  4. Leng G, Ranft U, Sugiri D, Hadnagy W, Berger-Preiss E, Idel H. Pyrethroids used indoors--biological monitoring of exposure to pyrethroids following an indoor pest control operation. Int J Hyg Environ Health 2003;206(2):85–92. DOI: 10.1078/1438-4639- 00199.
  5. Glickman AH, Casida JE. Species and structural variations affecting pyrethroid neurotoxicity. Neurobehav Toxicol Teratol 1982;4(6): 793–799.
  6. Soderlund DM. Molecular mechanisms of pyrethroid insecticide neurotoxicity: recent advances. Arch Toxicol 2011;86(2):165–181. DOI: 10.1007/s00204-011-0726-x.
  7. Forshaw PJ, Lister T, Ray DE. The role of voltage-gated chloride channels in type II pyrethroid insecticide poisoning. Toxicol Appl Pharmacol 2000;163(1):1–8. DOI: 10.1006/taap. 1999.8848.
  8. Bhaskar EM, Moorthy S, Ganeshwala G, Abraham G. Cardiac conduction disturbance due to prallethrin (pyrethroid) poisoning. J Med Toxicol 2010;6(1):27–30. DOI: 10.1007/s13181-010- 0032-7.
  9. Miyamoto J, Kaneko H, Tsuji R, Okuno Y. Pyrethroids, nerve poisons: how their risks to human health should be assessed. Toxicol Lett 1995;82–83:933–940. DOI: 10.1016/0378-4274(95)03604-0.
  10. Kumar S, Thomas A, Sahgal A, Verma A, Samuel T, Pillai MKK. Variations in the insecticide-resistance spectrum of Anopheles stephensi after selection with deltamethrin or a deltamethrin-piperonyl-butoxide combination. Ann Trop Med Parasitol 2004;98(8):861–871. DOI: 10.1179/000349804X3180.
  11. Martin T, Ochou OG, Vaissayre M, Fournier D. Organophosphorus insecticides synergize pyrethroids in the resistant strain of cotton bollworm, Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) from West Africa. J Econ Entomol 2003;96(2):468–474. DOI: 10.1093/jee/96.2.468.
  12. Chrustek A, Hołyńska-Iwan I, Dziembowska I, Bogusiewicz J, Wróblewski M, Cwynar A, et al. Current research on the safety of pyrethroids used as insecticides. Medicina (Kaunas) 2018;54(4):E61. DOI: 10.1016/j.jemermed.2017.12.056.
  13. Crofton KM, Kehn LS, Gilbert ME. Vehicle and route dependent effects of a pyrethroid insecticide, deltamethrin, on motor function in the rat. Neurotoxicol Teratol 1995;17(4):489–495. DOI: 10.1016/0892-0362(95)00008-f.
  14. He F, Wang S, Liu L, Chen S, Zhang Z, Sun J. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol 1989;63(1): 54–58. DOI: 10.1007/bf00334635.
  15. Dorman DC, Beasley VR. Neurotoxicology of pyrethrin and the pyrethroid insecticides. Vet Hum Toxicol 1991;33(3):238–243.
  16. Cha YS, Kim H, Cho NH, Jung WJ, Kim YW, Kim TH, et al. Pyrethroid poisoning: features and predictors of atypical presentations. Emerg Med J 2014;31(11):899–903. DOI: 10.1136/emermed-2013-202908.
  17. Panwar M, Usha G, Kumath M. Status epilepticus: an association with pyrethroid poisoning. Indian J Crit Care Med 2013;17(2):119–120. DOI: 10.4103/0972-5229.114825.
  18. Singh H, Luni FK, Marwaha B, Ali SS, Alo M. Transient complete heart block secondary to bed bug insecticide: a case of pyrethroid cardiac toxicity. Cardiology 2016;135(3):160–163. DOI: 10.1159/000446574.
  19. Mugundhan K, Iyer RS. Myelopathy following cypermethrin poisoning. J Assoc Physicians India 2016;64(9):85–86.
  20. Kim D, Moon J, Chun B. The initial hyperglycemia in acute type II pyrethroid poisoning. J Korean Med Sci 2015;30(4):365–370. DOI: 10.3346/jkms.2015.30.4.365.
  21. Iyyadurai R, Peter JV, Immanuel S, Begum A, Zachariah A, Jasmine S, et al. Organophosphate-pyrethroid combination pesticides may be associated with increased toxicity in human poisoning compared to either pesticide alone. Clin Toxicol (Phila) 2014;52(5):538–541. DOI: 10.3109/15563650.2014.909933.
  22. Tripathi M, Pandey R, Ambesh SP, Pandey M. A mixture of organophosphate and pyrethroid intoxication requiring intensive care unit admission: a diagnostic dilemma and therapeutic approach. Anesth Analg 2006;103(2):410–412. DOI: 10.1213/01.ane.0000222470.89210.5a.
  23. Hansen MR, Jørs E, Lander F, Condarco G, Schlünssen V. Is cumulated pyrethroid exposure associated with prediabetes? A cross-sectional study. J Agromedicine 2014;19(4):417–426. DOI: 10.1080/1059924X.2014.945708.
  24. Ding G, Shi R, Gao Y, Zhang Y, Kamijima M, Sakai K, et al. Pyrethroid pesticide exposure and risk of childhood acute lymphocytic leukemia in Shanghai. Environ Sci Technol 2012;46(24):13480–13487. DOI: 10.1021/es303362a.
  25. Oortgiesen M, van Kleef RGDM, Vijverberg HPM. Block of deltamethrin-modified sodium current in cultured mouse neuroblastoma cells: local anesthetics as potential antidotes. Brain Res 1990;518(1–2):11–18. DOI: 10.1016/0006-8993(94)90814-1.
  26. Drago B, Shah NS, Shah SH. Acute permethrin neurotoxicity: variable presentations, high index of suspicion. Toxicol Rep 2014;1:1026–1028. DOI: 10.1016/j.toxrep.2014.09.007.
  27. Hiromori T, Nakanishi T, Kawaguchi S, Sako H, Suzuki T, Miyamoto J. Therapeutic effects of methocarbamol on acute intoxication by pyrethroids in rats. J Pestic Sci 1986;11(1):9–14. DOI: 10.1584/jpestics.11.9.
  28. Peacock RE, Hosgood G, Swindells KL, Smart L. A randomized, controlled clinical trial of intravenous lipid emulsion as an adjunctive treatment for permethrin toxicosis in cats. J Vet Emerg Crit Care (San Antonio) 2015;25(5):597–605. DOI: 10.1111/vec.12322.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.