Abstract
We describe the hospital course of a 42-year-old patient who presented to the Emergency
Department following an ingestion of an unknown quantity of chlorfenapyr, an organochlorine
pesticide that acts as a mitochondrial uncoupler (MU). There is limited data on chlorfenapyr
toxicity in humans, but reports indicate a 100% mortality rate after a 7-10 day quiescent
period.3-6 Our patient was admitted for a 5-day asymptomatic observation period before
becoming critically ill. Supportive care, antioxidant therapy, and late hemodialysis
(HD) proved futile. The patient expired from complications due to uncontrollable hyperthermia
on hospital day 6. This case represents the first reported fatality due to chlorfenapyr
in North America, and illustrates: 1) its potency as a human toxin, 2) the futility
of extracorporeal decontamination once late toxicity has set in; 3) the potential
need for early and aggressive decontamination in the ED; and 4) the need for a better
understanding of this unique poison.
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References
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- 2,4 Dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death.J Med Toxicol. 2011; 7: 205-212
- The uncoupling of photophosphorylation by valinomycin and ammonium chloride.J Biol Chem. 1969; 244: 4292-4298
- Uncouplers and the molecular mechanism of uncoupling in mitochondria.Proc Natl Acad Sci U S A. Jun 1977; 74: 2241-2245
Article Info
Publication History
Published online: July 03, 2018
Accepted:
May 14,
2018
Received:
May 8,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
