Abstract
Study objective: Avermectins have been used in the control of parasites and insects; however, human
data concerning poisoning are lacking. This study investigated the clinical spectrum
of avermectin poisoning. Methods: A retrospective study was conducted to evaluate patients with avermectin poisoning
reported to a poison center from September 1993 through December 1997. Results: Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with
ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion were identified. There were 14
male and 5 female patients, ranging in age from 15 to 83 years. Most patients were
exposed as a result of attempted suicide (14). Oral ingestion (15) was the most common
route of exposure. Four patients were asymptomatic, and 8 had minor symptoms after
a mean ingestion of 23 mg/kg abamectin (4.2 to 67 mg/kg), or after dermal and inhalation
contact. Seven patients manifested severe symptoms, such as coma (7), aspiration with
respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg
avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). All 7 patients
received intensive supportive care; 1 patient died 18 days later as a result of multiple
organ failure. Conclusion: Ingestion of a large dose of avermectin may be associated with life-threatening coma,
hypotension, and subsequent aspiration. [Chung K, Yang C-C, Wu M-L, Deng J-F, Tsai
W-J: Agricultural avermectins: An uncommon but potentially fatal cause of pesticide
poisoning. Ann Emerg Med July 1999;34:51-57.]
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Article Info
Publication History
Accepted:
April 19,
1999
Received in revised form:
December 16,
1998
Received in revised form:
February 22,
1999
Received:
July 7,
1998
Footnotes
☆Address for reprints: Chen-Chang Yang, MD, Division of Clinical Toxicology, Department of Medicine, Veterans General Hospital–Taipei, 201, Section 2, Shih-Pai Road, Taipei, Taiwan, 11217; 886-2-28717121, fax 886-2-28739193; E-mail [email protected]
☆☆0196-0644/99/$8.00 + 0
★47/1/99330
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Copyright
© 1999 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
