ABSTRACT
Neonicotinoids are a new class of insecticides widely applied for crop protection. Information on human exposures to neonicotinoids is limited. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death the high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. Present study report three cases presented to us with acute neonicotinoid poisoning with different manifestations including acute myocardial infarction, central nervous system (CNS) depression, and acute kidney injury, who recovered subsequently with supportive care. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients.