pralidoxime and Hyperglycemia

Amitraz is used as an ectoparasiticide for dogs and cattle. Human poisoning due to amitraz may be misdiagnosed as organophosphate/carbamate (OPC) toxicity, since amitraz poisoning shares several clinical features (miosis, bradycardia and hypotension) encountered with OPC poisoning. A 19-year-old man with an alleged history of suicidal ingestion of a pesticide presented with drowsiness and was found to have constricted pupils, hypotension and bradycardia. He was diagnosed as a case of OPC poisoning and was treated with atropine and pralidoxime prior to presentation to our centre. Absence of a hypersecretory state, and the presence of hyperglycaemia and hypothermia along with a normal serum cholinesterase level suggested an alternate possibility. Retrieval of the poison container confirmed the diagnosis of amitraz poisoning. The patient made a rapid recovery with supportive management. Clinician awareness is key to successful management of this poisoning, which carries a good prognosis.

Topics: Atropine; Bradycardia; Cholinesterase Reactivators; Diagnosis, Differential; Diagnostic Errors; Follow-Up Studies; Humans; Hyperglycemia; Hypotension; Male; Miosis; Organophosphate Poisoning; Parasympatholytics; Pralidoxime Compounds; Suicide, Attempted; Toluidines; Treatment Outcome; Young Adult