Poisoning with amitraz, an overlooked pesticide, in an adolescent boy in Kenya

Abstract

Introduction: Amitraz is a formamidine chemical compound used worldwide as an ectoparasiticide and an agricultural pesticide. Despite its widespread use, very few cases of human poisoning have been described leading to low awareness among health care providers. Some of its effects on humans may mimic organophosphate poisoning. As a result, cases of amitraz intoxication are not recognized and are therefore incorrectly treated as the much more commonly recognized organophosphate poisoning. There is currently no known antidote for amitraz poisoning and the management is mainly supportive and symptomatic. Case Report: We report a case of a 12-year-old boy who presented to the emergency department with depressed level of consciousness, miosis, bradycardia and hypothermia following deliberate ingestion of a pesticide. Baseline laboratory studies were notable of hyperglycemia and glycosuria but no ketonuria. His past medical history was unremarkable with no history of diabetes mellitus or drug abuse. The poisoning was initially incorrectly diagnosed as organophosphate intoxication but later changed to amitraz poisoning. He was successfully managed supportively with oxygen supplementation, airway management, intravenous fluids as well as close monitoring. Conclusion: This case report highlights the importance of considering other toxic agents/chemicals other than organophosphate in patients with poisoning. It also highlights the life-threatening presentation in amitraz poisoning, as well as the excellent prognosis with early recognition and supportive management.