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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Acute Human Self-Poisoning with the <italic>N</italic>-Phenylpyrazole Insecticide Fipronil –A GABA<sub>A</sub>-Gated Chloride Channel Blocker</title><author><name sortKey="Mohamed, Fahim" sort="Mohamed, Fahim" uniqKey="Mohamed F" first="Fahim" last="Mohamed">Fahim Mohamed</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Senarathna, Lalith" sort="Senarathna, Lalith" uniqKey="Senarathna L" first="Lalith" last="Senarathna">Lalith Senarathna</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Percy, Adrian" sort="Percy, Adrian" uniqKey="Percy A" first="Adrian" last="Percy">Adrian Percy</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Abeyewardene, Manel" sort="Abeyewardene, Manel" uniqKey="Abeyewardene M" first="Manel" last="Abeyewardene">Manel Abeyewardene</name><affiliation><nlm:aff id="A2">Bayer CropScience, Sophia Antipolis Research Center, France.</nlm:aff></affiliation></author><author><name sortKey="Eaglesham, Geoffrey" sort="Eaglesham, Geoffrey" uniqKey="Eaglesham G" first="Geoffrey" last="Eaglesham">Geoffrey Eaglesham</name><affiliation><nlm:aff id="A3">Queensland Health Scientific Services, Coopers Plains, Queensland, Australia</nlm:aff></affiliation></author><author><name sortKey="Cheng, Ron" sort="Cheng, Ron" uniqKey="Cheng R" first="Ron" last="Cheng">Ron Cheng</name><affiliation><nlm:aff id="A3">Queensland Health Scientific Services, Coopers Plains, Queensland, Australia</nlm:aff></affiliation></author><author><name sortKey="Azher, Shifa" sort="Azher, Shifa" uniqKey="Azher S" first="Shifa" last="Azher">Shifa Azher</name><affiliation><nlm:aff wicri:cut=" and" id="A4">Polonnaruwa</nlm:aff></affiliation></author><author><name sortKey="Hittarage, Ariyasena" sort="Hittarage, Ariyasena" uniqKey="Hittarage A" first="Ariyasena" last="Hittarage">Ariyasena Hittarage</name><affiliation><nlm:aff id="A5"> Anuradhapura General Hospitals, North Central Province, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Dissanayake, Wasantha" sort="Dissanayake, Wasantha" uniqKey="Dissanayake W" first="Wasantha" last="Dissanayake">Wasantha Dissanayake</name><affiliation><nlm:aff id="A5"> Anuradhapura General Hospitals, North Central Province, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Sheriff, Mh Rezvi" sort="Sheriff, Mh Rezvi" uniqKey="Sheriff M" first="Mh Rezvi" last="Sheriff">Mh Rezvi Sheriff</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Davies, Willie" sort="Davies, Willie" uniqKey="Davies W" first="Willie" last="Davies">Willie Davies</name><affiliation><nlm:aff id="A6">Bayer CropScience UK, Cambridge, England.</nlm:aff></affiliation></author><author><name sortKey="Buckley, Nick" sort="Buckley, Nick" uniqKey="Buckley N" first="Nick" last="Buckley">Nick Buckley</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation><affiliation><nlm:aff id="A7">Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, ACT, Australia.</nlm:aff></affiliation></author><author><name sortKey="Eddleston, Michael" sort="Eddleston, Michael" uniqKey="Eddleston M" first="Michael" last="Eddleston">Michael Eddleston</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation><affiliation><nlm:aff id="A8">Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">15641641</idno><idno type="pmc">1351141</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351141</idno><idno type="RBID">PMC:1351141</idno><date when="2004">2004</date><idno type="wicri:Area/Pmc/Corpus">002015</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002015</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Acute Human Self-Poisoning with the <italic>N</italic>-Phenylpyrazole Insecticide Fipronil –A GABA<sub>A</sub>-Gated Chloride Channel Blocker</title><author><name sortKey="Mohamed, Fahim" sort="Mohamed, Fahim" uniqKey="Mohamed F" first="Fahim" last="Mohamed">Fahim Mohamed</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Senarathna, Lalith" sort="Senarathna, Lalith" uniqKey="Senarathna L" first="Lalith" last="Senarathna">Lalith Senarathna</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Percy, Adrian" sort="Percy, Adrian" uniqKey="Percy A" first="Adrian" last="Percy">Adrian Percy</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Abeyewardene, Manel" sort="Abeyewardene, Manel" uniqKey="Abeyewardene M" first="Manel" last="Abeyewardene">Manel Abeyewardene</name><affiliation><nlm:aff id="A2">Bayer CropScience, Sophia Antipolis Research Center, France.</nlm:aff></affiliation></author><author><name sortKey="Eaglesham, Geoffrey" sort="Eaglesham, Geoffrey" uniqKey="Eaglesham G" first="Geoffrey" last="Eaglesham">Geoffrey Eaglesham</name><affiliation><nlm:aff id="A3">Queensland Health Scientific Services, Coopers Plains, Queensland, Australia</nlm:aff></affiliation></author><author><name sortKey="Cheng, Ron" sort="Cheng, Ron" uniqKey="Cheng R" first="Ron" last="Cheng">Ron Cheng</name><affiliation><nlm:aff id="A3">Queensland Health Scientific Services, Coopers Plains, Queensland, Australia</nlm:aff></affiliation></author><author><name sortKey="Azher, Shifa" sort="Azher, Shifa" uniqKey="Azher S" first="Shifa" last="Azher">Shifa Azher</name><affiliation><nlm:aff wicri:cut=" and" id="A4">Polonnaruwa</nlm:aff></affiliation></author><author><name sortKey="Hittarage, Ariyasena" sort="Hittarage, Ariyasena" uniqKey="Hittarage A" first="Ariyasena" last="Hittarage">Ariyasena Hittarage</name><affiliation><nlm:aff id="A5"> Anuradhapura General Hospitals, North Central Province, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Dissanayake, Wasantha" sort="Dissanayake, Wasantha" uniqKey="Dissanayake W" first="Wasantha" last="Dissanayake">Wasantha Dissanayake</name><affiliation><nlm:aff id="A5"> Anuradhapura General Hospitals, North Central Province, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Sheriff, Mh Rezvi" sort="Sheriff, Mh Rezvi" uniqKey="Sheriff M" first="Mh Rezvi" last="Sheriff">Mh Rezvi Sheriff</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation></author><author><name sortKey="Davies, Willie" sort="Davies, Willie" uniqKey="Davies W" first="Willie" last="Davies">Willie Davies</name><affiliation><nlm:aff id="A6">Bayer CropScience UK, Cambridge, England.</nlm:aff></affiliation></author><author><name sortKey="Buckley, Nick" sort="Buckley, Nick" uniqKey="Buckley N" first="Nick" last="Buckley">Nick Buckley</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation><affiliation><nlm:aff id="A7">Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, ACT, Australia.</nlm:aff></affiliation></author><author><name sortKey="Eddleston, Michael" sort="Eddleston, Michael" uniqKey="Eddleston M" first="Michael" last="Eddleston">Michael Eddleston</name><affiliation><nlm:aff id="A1">South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</nlm:aff></affiliation><affiliation><nlm:aff id="A8">Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of toxicology. Clinical toxicology</title><idno type="ISSN">0731-3810</idno><idno type="eISSN">1097-9875</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S16"><title>Objective</title><p id="P1">Fipronil, a broad spectrum <italic>N</italic>-phenylpyrazole insecticide that inhibits GABA<sub>A</sub>-gated chloride channels, has been in use since the mid-1990s. A high affinity for insect compared to mammalian GABA receptors results in lower animal toxicity than other insecticides blocking this channel. To date, only two accidental cases of fipronil poisoning in humans have been published.</p></sec><sec id="S17"><title>Case series</title><p id="P2">We report seven patients with fipronil self-poisoning seen prospectively in Sri Lanka together with pharmacokinetics for four patients. Non-sustained generalized tonic-clonic seizures were seen in two patients (peak measured plasma fipronil concentrations 1600 and 3744 μg/L); both were managed with diazepam without complications. A patient with a peak measured plasma concentration of 1040 μg/L was asymptomatic throughout his stay. Plasma concentration was still high at discharge 3–4 days post-ingestion when the patients were well. Retrospective review of >1000 pesticide poisoning deaths since 1995 found only one death from fipronil-based products. In contrast to the good outcome of the above cases, this patient required intubation and ventilation and had continuous fits despite therapy with barbiturates and benzodiazepines.</p></sec><sec id="S18"><title>Conclusions</title><p id="P3">Our experience with prospectively observed patients suggests that fipronil poisoning is characterized by vomiting, agitation, and seizures, and normally has a favorable outcome. Management should concentrate on supportive care and early treatment of seizures. However, further experience is needed to determine whether increased susceptibility to fipronil or larger doses can produce status epilepticus.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8213460</journal-id><journal-id journal-id-type="pubmed-jr-id">5319</journal-id><journal-id journal-id-type="nlm-ta">J Toxicol Clin Toxicol</journal-id><journal-id journal-id-type="iso-abbrev">J. Toxicol. Clin. Toxicol.</journal-id><journal-title-group><journal-title>Journal of toxicology. Clinical toxicology</journal-title></journal-title-group><issn pub-type="ppub">0731-3810</issn><issn pub-type="epub">1097-9875</issn></journal-meta><article-meta><article-id pub-id-type="pmid">15641641</article-id><article-id pub-id-type="pmc">1351141</article-id><article-id pub-id-type="manuscript">UKMS6527</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Acute Human Self-Poisoning with the <italic>N</italic>-Phenylpyrazole Insecticide Fipronil –A GABA<sub>A</sub>-Gated Chloride Channel Blocker</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mohamed</surname><given-names>Fahim</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Senarathna</surname><given-names>Lalith</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Percy</surname><given-names>Adrian</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Abeyewardene</surname><given-names>Manel</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Eaglesham</surname><given-names>Geoffrey</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Cheng</surname><given-names>Ron</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Azher</surname><given-names>Shifa</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Hittarage</surname><given-names>Ariyasena</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Dissanayake</surname><given-names>Wasantha</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Sheriff</surname><given-names>MH Rezvi</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Davies</surname><given-names>Willie</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Buckley</surname><given-names>Nick</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Eddleston</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A8">8</xref><xref rid="FN1" ref-type="author-notes"></xref></contrib><aff id="A1"><label>1</label>South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.</aff><aff id="A2"><label>2</label>Bayer CropScience, Sophia Antipolis Research Center, France.</aff><aff id="A3"><label>3</label>Queensland Health Scientific Services, Coopers Plains, Queensland, Australia</aff><aff id="A4"><label>4</label>Polonnaruwa and</aff><aff id="A5"><label>5</label> Anuradhapura General Hospitals, North Central Province, Sri Lanka.</aff><aff id="A6"><label>6</label>Bayer CropScience UK, Cambridge, England.</aff><aff id="A7"><label>7</label>Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, ACT, Australia.</aff><aff id="A8"><label>8</label>Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, England.</aff></contrib-group><author-notes><corresp id="FN1"><bold><italic>Correspondence:</italic></bold> M Eddleston, Dept of Clinical Medicine, Faculty of Medicine, POBox 271, 25 Kynsey Road, Colombo-08, Sri Lanka. Fax: +44-20-7900-3445.<email>eddlestonm@eureka.lk</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>28</day><month>11</month><year>2005</year></pub-date><pub-date pub-type="ppub"><year>2004</year></pub-date><pub-date pub-type="pmc-release"><day>25</day><month>1</month><year>2006</year></pub-date><volume>42</volume><issue>7</issue><fpage>955</fpage><lpage>963</lpage><abstract><sec id="S16"><title>Objective</title><p id="P1">Fipronil, a broad spectrum <italic>N</italic>-phenylpyrazole insecticide that inhibits GABA<sub>A</sub>-gated chloride channels, has been in use since the mid-1990s. A high affinity for insect compared to mammalian GABA receptors results in lower animal toxicity than other insecticides blocking this channel. To date, only two accidental cases of fipronil poisoning in humans have been published.</p></sec><sec id="S17"><title>Case series</title><p id="P2">We report seven patients with fipronil self-poisoning seen prospectively in Sri Lanka together with pharmacokinetics for four patients. Non-sustained generalized tonic-clonic seizures were seen in two patients (peak measured plasma fipronil concentrations 1600 and 3744 μg/L); both were managed with diazepam without complications. A patient with a peak measured plasma concentration of 1040 μg/L was asymptomatic throughout his stay. Plasma concentration was still high at discharge 3–4 days post-ingestion when the patients were well. Retrospective review of >1000 pesticide poisoning deaths since 1995 found only one death from fipronil-based products. In contrast to the good outcome of the above cases, this patient required intubation and ventilation and had continuous fits despite therapy with barbiturates and benzodiazepines.</p></sec><sec id="S18"><title>Conclusions</title><p id="P3">Our experience with prospectively observed patients suggests that fipronil poisoning is characterized by vomiting, agitation, and seizures, and normally has a favorable outcome. Management should concentrate on supportive care and early treatment of seizures. However, further experience is needed to determine whether increased susceptibility to fipronil or larger doses can produce status epilepticus.</p></sec></abstract><funding-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source><award-id>071669 || WT</award-id></award-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source><award-id>063560 || WT</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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