II. Background
- Chlorfenapyr is a pyrrole Insecticide
- Used as an Insecticide (cotton crops, greenhouse plants)
III. Mechanism
- Chlorfenapyr Exposure via Ingestion or Dermal absorption
- Chlorfenapyr is metabolized to active toxin
- Active toxin uncouples Oxidative Phosphorylation in mitochondria
- Decompensation and death may be delayed for 7-20 days
IV. Toxicology
- Toxicity at >10 ml ingestion
- Lethal at >20 ml ingestion- Delayed mortality for 7-20 days
 
V. Findings
- Cardiopulmonary- Hemodynamic instability
- Tachycardia
- Tachypnea
 
- Gastrointestinal
- Neurologic- Headache
- Altered Mental Status
- Paraparesis
- Vision Loss
- Leukoencephalopathy
 
- Metabolic- Fever or Hyperthermia
- Metabolic Acidosis
- Rhabdomyolysis
 
VI. Labs
- See Unknown Ingestion for general Toxicology Screening
- Comprehensive metabolic panel
- Venous Blood Gas
- Creatine Phosphokinase
VII. Management
- ABC Management (including Endotracheal Intubation as needed)
- Activated Charcoal with or without Gastric Lavage if recent ingestion (hours)
- Consider Whole Bowel Irrigation
- Hemodialysis is variably effective
- Disposition- Admit all symptomatic patients
- Asymptomatic patients may be discharged with careful home precautions and Temperature monitoring
 
VIII. Resources
- Chlorfenapyr (PubChem)
IX. References
- Tomaszewski (2021) Crit Dec Emerg Med 35(10): 32
- Kang (2014) J Emerg Trauma Shock 7(3): 239-41 +PMID: 25114438 [PubMed]
- Tharaknath (2013) Ann Indian Acad Neurol 16(2): 252-54 +PMID: 23956576 [PubMed]
