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Category: Volume 06 Issue 04 April 2018
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Title: AMITRAZ Poisoning:  Uncommon and Overlooked Human Toxicity of a Common Pesticide

Authors: Dr Dipankar Das, Dr Prabal Rajvanshi, Dr Gangadhar Buduga, Dr Rahul Arya,  Dr Mohd Javed

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.63

Abstract

Amitraz is a widely used pesticide worldwide. Chemically it is a triazapentadiene, having predominant effect as centrally acting α2 adrenergic agonist. Human toxicity of amitraz is an unusual occurrence mostly due to accidental ingestion or suicidal attempt and limited number of such cases have been published in the literature. Its toxicity clinically mimics commonly occurring Organophosphorus poisoning. Clinically it poses as threat to human life due to lack of awareness among clinician and lack of specific treatment protocol. Hereby reporting of our case prove beneficial to clinical practitioners.

This case is about a 17 yr old male ingesting amitraz 25ml of 12.5% w/v (3.12gm) in suicidal attempt on 29th, April, 2018 at 8.30pm. within 1 hour he developed nausea, dizziness and drowsiness for which he was taken to a primary clinic where Gastric lavage was done 1.5 hour after poisoning. Afterwards he was admitted in Safdarjung hospital, new Delhi, which is a tertiary care hospital. He developed miosis, bradycardia and respiratory depression. The patient improved gradually on atropine fluids and Inotropes. The patient regained consciousness in 26 hours after poisoning.

Conclusion: amitraz poisoning is accompanied with numerous symptoms varying from central nervous system depression (drowsiness, coma, and convulsion), to miosis, or, rarely, mydriasis, respiratory depression, bradycardia, hypotension, hypertension, hypothermia or fever, hyperglycemia, polyuria, vomiting, decreased gastrointestinal motility, and intestinal distension. Most symptoms are explained by its agonistic action of on α1 and α2 receptors. For Management a valid and proven antidote is not yet available for use on humans. So supportive care with atropine for bradycardia and IV fluids & if needed Inotropes greatly makes impact on the early recovery of the patient. Close monitoring for complications particularly central nervous system, respiratory system and cardiovascular system is of utmost importance.

Keywords: Amitraz, central nervous system, bradycardia, miosis supportive management,

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Corresponding Author

Dr Dipankar Das

Postgraduate resident, Department of General Medicine,

V.M.M.C and Safdarjung Hospital