Clinical Characteristics of Patients with Indoxacarb Insecticide Poisoning

PURPOSE: Indoxacarb insecticide poisoning causes methemoglobinemia, which is occasionally life-threatening. However, there is limited data on indoxacarb effects after human ingestion. The purpose of this study was to examine the clinical features, complications, management, and medical outcome of patients with indoxacarb insecticide poisoning. METHODS: We retrospectively reviewed the medical records of 10 patients with indoxacarb insecticide poisoning who had visited our emergency centers from January 2008 to December 2011. We collected data on the general characteristics of the patients, their clinical symptoms and signs, laboratory data, management of their condition, and clinical results. RESULTS: Among the 10 patients, 8 were diagnosed with methemoglobinemia. The clinical manifestations of indoxacarb insecticide poisoning were hypotension (3 patients), altered mentality (5 patients), cyanosis (5 patients), dyspnea (2 patients), seizure (3 patients), and cardiac arrest (2 patients). Four patients had a poisoning severity score of 3 and 2 patients had a poisoning severity score of 2. Four patients were treated with methylene blue for methemoglobinemia and one patient was treated with a high dose (150 mg/kg) of ascorbic acid. The serum methemoglobin saturation of five patients who were treated with methylene blue or a high dose of ascorbic acid was nearly normalized. Four patients experienced rhabdomyolysis, pneumonia, hemolytic anemia, acute pancreatitis, and heart failure as a complication of indoxacarb insecticide poisoning. CONCLUSION: We observed a variety of clinical features, complications, management, medical outcome, and clinical course of patients with indoxacarb insecticide poisoning. We could also ascertain the efficacy of methylene blue and high dose ascorbic acid for indoxacarb-induced metheglobinemia.

Early Factors Affecting Prognosis of Patients with Hanging Injury

PURPOSE: Hanging is a common method of suicide around the world. The prognosis after hanging injury is highly variable. Some patients die despite intensive treatment, while other patients recover without neurologic sequelae. The purpose of this study was to identify several prognostic factors affecting the outcome in patients with hanging injury. METHODS: Thirty-five patients presented at Gyeongsang National University Hospital between May 2005 and July 2009 following hanging injury. Patients, of whom 30 were unconscious, were classified as being in the initial mental status. For these patients, we investigated several factors and identified correlations between factors and prognosis. We investigated the type of hanging, mental status, presence of pupillary light reflex, glasgow coma scale (GCS), laboratory findings, presence of cardiopulmonary resuscitation (CPR) and intubation, history of psychiatric disease, alcohol use, hanging duration, brain computed tomography (CT), and injury of the spine and neck soft tissue. RESULTS: Factors suggesting a poor prognosis factors were complete hanging, poor mental status, the absence of pupillary light reflex, initial GCS, pH, bicarbonate and excess level of base, the practice of CPR and intubation. In particular, patients who showed GCS scores lower than 4.5 in the emergency room were highly likely to die. CONCLUSION: Patients after hanging injury can recover without neurologic sequelae despite altered mental status. The prognosis of patients who present with hanging injury can be established by the type of hanging, initial mental status, the presence of pupillary light reflex, initial GCS, arterial blood gas analysis (ABGA), and the practice of CPR and intubation. Therefore patients with hanging injury should be treated aggressively with consideration of prognostic factors.

Related Factors and their Effects on Acute Renal Failure Resulting from Rhabdomyolysis after Pesticide Intoxication

PURPOSE: Rhabdomyolysis is one of the most important complications of pesticide intoxication. It affects a patient's clinical prognosis and can cause acute renal failure. It is important that patients diagnosed with pesticide intoxication receive an accurate initial diagnosis and proper treatment to prevent significant complications. This study's objective was to investigate and confirm related factors causing acute renal failure by verifying clinical observations and laboratory findings collected following pesticide intoxication. METHODS: A retrospective analysis was made of 734 patients who presenting to our emergency medical center after ingesting pesticides between January 2006 and December 2008. Of these, 513 patients were selected for the study. Two hundred and twenty-one patients were excluded because of paraquat intoxication, age (if under 18), or chronic renal failure. Seventy-four patients were diagnosed with rhabdomyolysis, based on serum creatinine phosphokinase levels were >1,000 U/L. Acute renal failure was diagnosed when creatinine levels were > 2.0 mg/dL. RESULTS: Among the 74 patients diagnosed with rhabdomyolysis, 26 (35.1%) experienced acute renal failure. The most meaningful related factor in the prediction of acute renal failure was initial arterial pH and creatinine level. CONCLUSION: Initial arterial pH and creatinine level are predictors of complications such as acute renal failure in patients with rhabdomyolysis.