J Korean Soc Emerg Med.  2012 Oct;23(5):750-752.

Methemoglobinemia and Seizure Following Indoxacarb Poisoning

• Oh YM
• Choi KH
• Lee KU

Abstract

Indoxacarb is an oxadiazine insecticide with selective lethality through blockade of neuronal voltage-dependent sodium channels. It has a low mammalian toxicity, and few cases of human toxicity after indoxacarb ingestion can be found in the literature. A 36 year-old male patient visited our ED after a generalized tonic clonic seizure, which was witnessed by his mother. His past medical history was nonspecific. On initial presentation, he showed a decreased level of consciousness with a Glasgow coma score of 5/15 (E1V1M3), unprotected airway, hypoxia, and cyanosis. The saturation gap and cyanosis after intubation and mechanical ventilation was strongly suggestive of methemoglobinemia due to poisoning. Finally, the methemogobin (metHb) level was 27.4%. Therefore, the patient received 100 mg of methylene blue (2 mg/kg, 1% solution) and 50 g of charcoal. The insecticide was found to be ingested xenobiotic (Steward Gold(R); 5% indoxacarb; 95% inert ingredients and other components). On the second hospital day, the patient became alert. The patient's metHb level was 0.1%. The endotracheal tube was removed. On the fifth hospital day, he was discharged in good condition. Herein we present a case of indoxacarb poisoning with methemoglobiemia and seizure, which are unusual presentations.

Keyword

Indoxacarb; Poisoning; Methemoglobinemia; Seizure

MeSH Terms

Anoxia
Charcoal
Coma
Consciousness
Cyanosis
Eating
Humans
Intubation
Male
Methemoglobinemia
Methylene Blue
Mothers
Neurons
Oxazines
Respiration, Artificial
Seizures
Sodium Channels
Wit and Humor as Topic
Charcoal
Methylene Blue
Oxazines
Sodium Channels