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Atropine/naloxone/sodium-chloride Lack of efficacy: case report

A 27-year-old man exhibited lack of efficacy during treatment with atropine, naloxone and sodium chloride [not all routes stated]. The man, who was a cattle farmer, was referred to the Emergency Department (ED) following intentional ingestion of a 20mL bottle of a pesticide 4 hours prior to arrival. The active ingredient of the pesticide was amitraz. Initially, he was unresponsive and showed miotic pupils, a narrow complex bradycardia, hypotension, hypoxia, a temperature of 37.4°C and depressed respirations. Supportive care including IV access, oxygen via a nonrebreather, and a 2 liter bolus of sodium chloride [normal saline] were rapidly initiated. Naloxone 6mg and atropine 1mg were administered without any response. Repeat blood pressure was unobtainable by peripheral cuff, and central pulses were significantly reduced in amplitude. The man received epinephrine with amelioration in haemodynamics. Subsequently, he was intubated and mechanically ventilated. Dopamine was initiated for continued bradycardia and hypotension. He was admitted to the ICU and was weaned off inotropic support within 12 hours. Approximately 24 hours following initial ingestion, he spontaneously awoke and self-extubated with full recovery. Shortly thereafter, he was discharged from hospital. Wallace D, et al. Amitraz: An unfamiliar insecticide with familiar toxicity. Clinical Toxicology 58: 520-521, No. 6, Jan 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]

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Reactions 26 Sep 2020 No. 1823