A Case of Acute Fenvalerate

A 49-year-old man ingested about 200ml of Fenvalerate (synthetic pyrethroid)-Dimethoate (organophosphate) mixture with suicidal intent. He was in deep coma (GCS 3) on admission, 1 hour after ingestion, with a pupil size of 6mm on both sides. He had tachycardia, hypotension, hyperemic bulbar conjunctiva, blushed skin, and decreased activity of serum cholinesterase (Δph 0.45). These signs were compatible with pyrethroid poisoning. He was intubated and received gastric lavage. Six hours after ingestion, he developed systemic muscular fasciculation and clonic convulsion. Diazepam, midazolam, and vecuronium were given intravenously, but both conditions gradually worsened. Twelve hours after ingestion, he showed signs of organophosphate poisoning, such as miosis, increased salivation, and low serum cholinesterase (ΔpH 0.01). Atropine was given intravenously and he underwent direct hemoperfusion (DHP) on the 2nd and 3rd hospital days. Strong muscular fasciculation and convulsion markedly decreased after the 1st DHP. The patient was discharged on the 20th hospital day without any neurological sequelae.This case suggests that the signs of pyrethroid poisoning may develop very early and DHP that is effective for frcating muscular fasciculation and convulsion due to poisoning pyrefhroid.