Neonicotinoid insecticides have a low risk of toxicity in humans when properly used but an excessive exposure can be fatal.
Examples: imidacloprid (1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine)
Mechanism of action: agonist at postsynaptic nicotinic acetylcholine receptors in insects, causing neuromuscular paralysis
The patient may present with cholinergic symptoms resembling acute nicotine poisoning.
Clinical findings:
(1) mild disorientation
(2) bradycardia
(3) ventricular arrhythmia
(4) metabolic acidosis
(5) gastrointestinal irritation
Complications may include:
(1) a syndrome resembling leukocytoclastic vasculitis
(2) aspiration pneumonia
(3) respiratory failure
(4) multi-organ failure
(5) shock
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Specialty: Toxicology, Emergency Medicine, Critical Care
