Lambda- Cyhalothrin Pyrethroid Poisoning Presenting as Organophosphorus Poisoning

Abstract

Introduction: Lambda Cyhalothrin Pyrethroid is an uncommon lethal poison presenting with signs and symptoms that mimic organophosphorus poisoning. We present a case of a 16-year-old female presenting to the department of emergency medicine with an alleged history of ingestion of Kargol compound 20 ml containing Lambda Cyhalothrin Pyrethroid with a suicidal intention. At the time of presentation, her GCS was 3/15, bilateral pin point pupil, unrecordable blood pressure, pulse rate 40/minute, respiratory rate of 40/min, bilateral crepitations and oxygen saturation 52% on room air. She had multiple episodes of vomiting, nausea, diarrhea, and sweating. She was resuscitated immediately with 2 liters of normal saline, noradrenaline, and intubated with endotracheal tube of 7 mm ID. Atropine challenge test done was negative. Pralidoxime was started after atropinization. The patient had severe high-anion-gap metabolic acidosis and was managed with 8.4% sodium bicarbonate and fluids. After 6 hours of presentation, patient’s party brought a box which showed that the compound was 10% pyrethroid, and atropine and pralidoxime were immediately stopped. She was managed with intravenous fluid, antibiotics, and Ivermectin, but despite all measures, she expired on the 2nd day of admission. Pyrethroid poisoning should be a differential diagnosis in organophosphorus poisoning.