DEET Poisoning

Aka: DEET Poisoning, Acute DEET Toxicity

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II. Pathophysiology

  1. DEET Toxicity is rare outside of large ingestions or excessive application to skin
  2. Toxicity
    1. Neurologic Effects
    2. Cholinergic Toxicity (weak, reversible Cholinesterase Inhibitor)

III. Pharmacokinetics

  1. Excessive Skin exposure (>10% solutions)
    1. Skin absorbs 50% of the DEET applied (levels peak at 1 hour)
  2. Large Ingestion (e.g. >1 to 2 ml of a 50% solution)
    1. Levels peak at 30 minutes
  3. Other exposures
    1. DEET Inhalation is also possible
  4. Metabolism
    1. Hepatic metabolism
    2. Renal excretion of 70% of DEET within 24 hours

IV. Findings

  1. General
    1. Nausea and Vomiting
    2. Skin reactions (e.g. Urticaria) are uncommon
  2. Cardiovascular
    1. Bradycardia
    2. Hypotension
  3. Neuromuscular
    1. Muscle Weakness
    2. Myoclonus
    3. Acute Respiratory Failure
    4. Encephalopathy
    5. Seizures

V. Labs

  1. See Unknown Ingestion

VI. Management

  1. Decontamination
    1. See Decontamination After Toxin Exposure
    2. Wash skin off of residual DEET
    3. Avoid Activated Charcoal for DEET exposure
      1. DEET absorption and effects are too rapid to be affected by charcoal
  2. Hypotension
    1. Manage Hypotension with Intravenous Fluids (and Norepinephrine if fluid refractory)
  3. Seizures
    1. See Status Epilepticus
    2. Benzodiazepines or Barbiturates

VII. References

  1. Tomaszewski (2023) Crit Dec Emerg Med 37(8): 32

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