Document Type : Case Report


1 Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Egypt.

2 Department of Community Medicine, Industrial Medicine and Occupational Health, Faculty of Medicine, Alexandria University, Egypt.


Background: Cholinesterase inhibitor (ChEI) insecticide is a common cause of poisoning in developing countries. Toxicity occurs by ingestion, inhalation, or dermal absorption. However, only a few cases of parenteral poisoning have been reported. Inhibition of cholinesterase itself is not enough to explain the wide range of disorders associated with ChEIs insecticide exposure. Oxidative stress is supposed to be a contributing factor to the complications of ChEIs insecticide poisoning. L-carnitine (LC) is a widely accessible antioxidant therapy that is a safe drug with fewer side effects. It could be a promising adjuvant treatment in acute ChEIs insecticide poisoning.
Case presentation: The current case report describes a 60-year-old male with a homicidal intramuscular injection of ChEI insecticide, presented with chest crepitations and fasciculations. He showed an initial improvement to treatment with atropine, toxogonin, and L-carnitine (LC). However, there was a relapse of more aggressive manifestations after recovery and hospital discharge
Conclusion: Diagnosis of ChEI toxicity by the parenteral route is a challenge where the onset of symptoms may be delayed with atypical presentations. Even though the symptoms are mild initially, observation for a more extended period is mandatory. LC could be a promising adjuvant antioxidant treatment in acute ChEIs insecticide poisoning cases.


Main Subjects


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