2. Academic Validation
  3. A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels

A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels

  • Medicina (Kaunas). 2022 Nov 11;58(11):1630. doi: 10.3390/medicina58111630.
Ming-Jin Chung 1 2 3 4,  Yan-Chiao Mao 3 4 5,  Chia-Tien Hsu 6 7,  Mu-Chi Chung 5 6,  Tsai-Jung Wang 6 7 8,  Tung-Min Yu 5 6,  Po-Yu Liu 5 9 10,  Pin-Kuei Fu 5 11,  Chia-Ming Hsieh 4 5
Affiliations

Affiliations

  • 1 Department of Emergency Medicine, Hualien Armed Forces General Hospital, Hualien 971051, Taiwan.
  • 2 Department of Emergency Medicine, Tri-Service General Hospital, Taipei 114202, Taiwan.
  • 3 National Defense Medical Center, School of Medicine, Taipei 114202, Taiwan.
  • 4 Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
  • 5 College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan.
  • 6 Department of Internal Medicine, Division of Nephrology, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
  • 7 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
  • 8 Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
  • 9 Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan.
  • 10 Department of Internal Medicine, Division of Infectious Diseases, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
  • 11 Department of Medical Research, Division of Clinical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
PMID: 36422169 DOI: 10.3390/medicina58111630
Abstract

Chlorfenapyr is a new contact and stomach Insecticide derived from natural pyrroles secreted by Streptomyces spp. It is a pro-insecticide and acts after metabolic transformation to its active metabolite tralopyril. Tralopyril is an uncoupler of Oxidative Phosphorylation in the mitochondria of the target insects and of experiment Animals, leading to the disruption of adenosine triphosphate synthesis and death. Several fatal human poisonings had been reported and no blood chlorfenapyr or tralopyril measurements were available. The treatment remains supportive. A 32-year-old healthy man ingested 200 mL of 10% chlorfenapyr as a suicide attempt. Unfortunately, he succumbed at 157 h post-ingestion, shortly after having fever and seizures. His serum level of chlorfenapyr at 4 h post-exposure was 77.4 ng/mL, and was undetectable at 113 and 156 h, respectively. The serum levels of tralopyril were 723.6, 14,179, and 9654.2 ng/mL at 4, 113, and 156 h post-ingestion, respectively. The delay in the rise of serum tralopyril levels was noticeable, which seems to correlate with the patient's signs and symptoms. The information may have therapeutic implications in the management of this deadly poisoning.

Keywords

chlorfenapyr; death; fever; seizure; tralopyril.

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