Effect of hemopurification on acute chlorfenapyr poisoning / 中华急诊医学杂志

Objective:To evaluate the therapeutic effect of hemopurification on acute chlorfenapyr poisoning according to the blood concentration of chlorfenapyr and to provide experience for clinical treatment.Methods:Two patients who presented to our Emergency Department following an ingestion of chlorfenapyr and then were treated with hemopurification in 2022 were included. The concentrations of chlorfenapyr and its highly toxic metabolite tralopyril were dynamically monitored, and the clinical data of the patients were collected.Results:Case 1 was given hemoperfusion for the first time 13 hours after ingestion. During l hour hemoperfusion, the tralopyril decreased by 28.82%. The concentration increased and exceeded the pre-perfusion level after 2 hours of hemoperfusion. After three times of hemoperfusion, the concentrations of chlorfenapyr and tralopyril were still higher than those before the first time, reaching 248 ng/mL and 1 307 ng/mL respectively. The concentration of chlorfenapyr showed a downward trend after 130 h, and the tralopyril in blood reached the peak 3 164 ng/mL at 130 h and decreased to 2 707 ng/mL at 178 h. In case 2, the blood chlorfenapyr and tralopyril concentration was 392 ng/mL and 7 598 ng/mL respectively 150 hours after ingestion. The blood chlorfenapyr concentration decreased by 37.75% respectively after first hemoperfusion, and the tralopyril concentration decreased by 38.02% respectively. During 85 hours of continuous veno-venous hemodiafiltration (CVVHDF), the concentration of tralopyril was maintained at 4 234~6 410 ng/mL. Case 1 was followed up to 12 days and lost follow-up. Case 2 died and the survival time was 247 hours.Conclusions:Hemoperfusion can scavenge tralopyril, but CVVHDF has poor scavenging ability for tralopyril. And the apparent volume of distribution (Vd) of chlorfenapyr and tralopyril are large. After ingestion, chlorfenapyr spreads to various tissues quickly, and it is easy to accumulate in the adipose tissue. The chlorfenapyr in the tissue slowly is released back to the blood and stays in the blood for a long time. The peak concentration of chlorfenapyr appeared earlier than that of tralopyril. Clinicians should pay attention to the early removal of toxins from the digestive tract.

Three cases of acute chlorfenapyr poisoning / 中华劳动卫生职业病杂志

This paper reported 3 cases of poisoning caused by chlorfenagyr. Chlorfenapyr poisoning has gradually increased in clinical practice. The early stage after poisoning is digestive tract symptoms, followed by sweating, high fever, changes in consciousness, changes in myocardial enzymology, etc. Its main mechanism of intoxication is uncoupling oxidative phosphorylation. Since there is no specific antidote after poisoning, the fatality rate of chlorfenapyr poisoning remains high. The therapeutic measures are early gastrointestinal decontamination, symptomatic and supportive treatments, and early blood purification may be an effective treatment.

Two cases of acute chlorfenapyr poisoning and literature review / 中华劳动卫生职业病杂志

In recent years, chlorfenapyr poisoning has gradually increased in clinical practice, but the case fatality rate remains high. At present, the research on its poisoning mechanism and clinical characteristics is limited, and there is no effective treatment. In order to summarize the clinical characteristics of chlorfenapyr poisoning, in order to guide the clinical treatment, this article reported 2 cases of acute chlorfenayr poisoning and 21 cases of literature review, and summarized the clinical characteristics of chlorfenapyr poisoning.Most of the symptoms of gastrointestinal symptoms, profuse sweating, high fever, and changes in consciousness after chlorfenapyr poisoning, and delayed exacerbations are common, which can involve multiple organ systems such as the central nervous system, providing a basis for clinical diagnosis and treatment.

Delayed central nervous system damage caused by chlorfenapyr-indoxacarb poisoning: a case report / 中华神经科杂志

Chlorfenapyr and indenocarb are two new insecticides widely used in the world. In recent years, there have been a few cases of human being being poisoned by chlorfenapyr or indenocarb respectively at home and abroad, but no cases of poisoning caused by chlorfenapyr or indenocarb have been reported. A case of delayed central nervous system damage after chlorfenapyr and indoxacarb poisoning was reported for clinical reference.

Detection Method and Degradation Dynamics of Chlorfenapyr in Honeysuckle Under Field Conditions / 中国药学杂志

OBJECTIVE: To develop a gas chromatography (GC) method for determination of chlorfenapyr in flower buds of Lonicera japonica Thunb, and study the degradation dynamics of chlorfenapyr in honeysuckle collected through field experiment, thus providing theoretical references for the application of chlorfenapyr in practical production of honeysuckle. METHODS: Honeysuckle samples were extracted with acetone using a vortex mixer and then cleaned up by passing through a neutral alumina chromatography column, followed by detection by gas chromatography with electronic capture detector (GC-ECD). External standard method was used for quantification. RESULTS: At fortified levels of 0.02-0.5 mg•kg-1, the average recoveries of chlorfenapyr in honeysuckle were from 83.9% to 97.6%, with RSDs of 0.6%-9.2%. The limit of detection was estimated to be 7.3 μg•kg-1. The degradation dynamics of chlorfenapyr in honeysuckle conformed to first-order dynamic equation. The degradation half-life of chlorfenapyr was 2.3 d. CONCLUSION: The method developed in this experiment is simple, rapid, reliable and in line with the requirements of pesticide residue analysis. The degradation rate of chlorfenapyr in honeysuckle is relatively rapid. Chlorfenapyr belongs to pesticides which are liable to degradation.

Toxic Optic Neuropathy Caused by Chlorfenapyr Poisoning

PURPOSE: To report a case of toxic optic neuropathy caused by chlorfenapyr ingestion accompanied by central nervous system involvement. CASE SUMMARY: A 44-year-old female visited our clinic complaining of reduced visual acuity in both eyes for 7 days. She had ingested a mouthful of chlorfenapyr for a suicide attempt 2 weeks prior to the visit. Gastric lavage was performed immediately after ingestion at the other hospital. Her best-corrected visual acuity was finger count 30 cm in the right eye and hand motion in the left eye. Both pupils were dilated by 5.0 mm and the response to light was sluggish in both eyes. A relative afferent pupillary defect was detected in her left eye. Funduscopy revealed optic disc swelling in both eyes. Magnetic resonance imaging of the brain showed a symmetric hyper-intense signal in the white matter tract including the internal capsule, corpus callosum, middle cerebellar peduncle, and brainstem. The patient was diagnosed with toxic optic neuropathy induced by chlorfenapyr ingestion, and underwent high-dose intravenous corticosteroid pulse therapy. Three days later, the best-corrected visual acuity was no light perception in both eyes. Three months later, optic atrophy was observed in both eyes. Optical coherence tomography revealed a reduction in the thicknesses of the retinal nerve fiber layer and ganglion cell and inner plexiform layer in the macular area. CONCLUSIONS: Ingestion of even a small amount of chlorfenapyr can cause severe optic nerve damage through the latent period, despite prompt lavage and high-dose steroid treatment.

Reporte de caso: intoxicación por clorfenapir con desenlace fatal / Report a case: chlorfenapyr intoxication with a fatal ending

El clorfenapir es un insecticida de uso agrícola, cuya ingesta en las personas produce un envenenamiento que a veces es fatal. Se presenta un caso clínico de paciente de sexo masculino con ingesta por vía oral del clorfenapir, con presentación de un cuadro compatible con deterioro neurológico y rabdomiolisis con desenlace fatal a pesar del tratamiento de soporte. El mecanismo de acción de esta substancia es la inhibición de la fosforilación oxidativa en las mitocondrias y se postula que este sea el mecanismo condicionante de la mortalidad en las personas, con lesiones en órganos principales como SNC y musculo, reportados en casos clínicos alrededor del mundo.

Chlorfenapyr is an insecticide for agricultural use, whose ingestion in people produces a poisoning that is sometimes fatal. It is presented a clinical case of a male patient with oral intake of chlorfenapyr, presenting a likeness compatible with neurological deterioration and rhabdomyolysis with fatal outcome despite supportive treatment. The mechanism of action of this substance is the inhibition of oxidative phosphorylation in the mitochondria and it is postulated that this is the conditioning mechanism of mortality in people, with lesions in major organs such as CNS and muscle, reported in clinical cases around the world.

Chlorfenapyr-Induced Toxic Leukoencephalopathy with Radiologic Reversibility: A Case Report and Literature Review

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.

Pesticidas como método suicida: un reporte de caso con Chlorfenapyr / Use of Pesticides as a Suicide Method: A Case Report with Chlorphenapyr

Introducción: La intoxicación con pesticidas es uno de los tres métodos más utilizados actualmente con fines suicidas debido a su fácil acceso. Objetivo: Discutir el curso clínico de la intoxicación con Chlorfenapyr y el uso de pesticidas con fi nes suicidas. Método: Reporte de caso. Resultados: Se reporta el caso de una mujer de 42 años, trabajadora en un cultivo de flores, quien ingresa a un hospital por intoxicación exógena con Chlorfenapyr con fines suicidas. Inicialmente presenta diaforesis, cefalea y tos seca. Se instaura manejo sintomático, pero al séptimo día de la ingesta presenta rápido deterioro neurológico y del patrón respiratorio, lo cual lleva a la muerte de la paciente. Discusión y conclusiones: Los pesticidas son una causa frecuente de las muertes por suicidio en el personal que trabaja en cultivos; teniendo en cuenta que aún no existe un antídoto contra el Chlorfenapyr, es prioritario enfatizar en el establecimiento de programas de salud pública y ocupacional encaminados a evaluar la salud mental del personal que trabaja en estas áreas y de este modo brindar un tratamiento adecuado y oportuno, que disminuya las tasas de suicidio y mejore la calidad de vida de estos trabajadores.

Introduction: One of the three most used methods with suicidal purposes is the intoxication with pesticides, due to its easy access. Objective: To discuss the clinical course of intoxication with Chlorphenapyr and the use of pesticides with suicidal purposes. Method: Case report. Results: The case of a 42 year old female fl ower plantation worker is reported. She enters the hospital due to exogenous intoxication with Chlorphenapyr with suicidal purposes, initially presenting diaphoresis, headache and cough. Symptomatic management is initiated, but after seven days she presents neurological and respiratory deterioration, causing her death Discussion and conclusions: Pesticides are a common cause of suicide in plantation workers. Taking into account that there is no antidote for Chlorphenapyr it is imperative to establish public health and occupational programs and to assess the mental health of staff working in this area providing adequate and timely treatment, in order to diminish suicide rates and improve the quality of life of these workers.