Chlorfenapyr Poisoning

Aka: Chlorfenapyr Poisoning, Chlorfenapyr Overdose, Chlorfenapyr Toxicity, Chlorfenapyr

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II. Background

  1. Chlorfenapyr is a pyrrole Insecticide
  2. Used as an Insecticide (cotton crops, greenhouse plants)

III. Mechanism

  1. Chlorfenapyr Exposure via Ingestion or Dermal absorption
  2. Chlorfenapyr is metabolized to active toxin
  3. Active toxin uncouples Oxidative Phosphorylation in mitochondria
  4. Decompensation and death may be delayed for 7-20 days

IV. Toxicology

  1. Toxicity at >10 ml ingestion
  2. Lethal at >20 ml ingestion
    1. Delayed mortality for 7-20 days

V. Findings

  1. Cardiopulmonary
    1. Hemodynamic instability
    2. Tachycardia
    3. Tachypnea
  2. Gastrointestinal
    1. Nausea or Vomiting
    2. Diarrhea
    3. Abdominal Pain
    4. Acute Pancreatitis
  3. Neurologic
    1. Headache
    2. Altered Mental Status
    3. Paraparesis
    4. Vision Loss
    5. Leukoencephalopathy
  4. Metabolic
    1. Fever or Hyperthermia
    2. Metabolic Acidosis
    3. Rhabdomyolysis

VI. Labs

  1. See Unknown Ingestion for general Toxicology Screening
  2. Comprehensive metabolic panel
  3. Venous Blood Gas
  4. Creatine Phosphokinase

VII. Management

  1. ABC Management (including Endotracheal Intubation as needed)
  2. Activated Charcoal with or without Gastric Lavage if recent ingestion (hours)
  3. Consider Whole Bowel Irrigation
  4. Hemodialysis is variably effective
  5. Disposition
    1. Admit all symptomatic patients
    2. Asymptomatic patients may be discharged with careful home precautions and Temperature monitoring

VIII. Resources

  1. Chlorfenapyr (PubChem)
    1. https://pubchem.ncbi.nlm.nih.gov/compound/Chlorfenapyr

IX. References

  1. Tomaszewski (2021) Crit Dec Emerg Med 35(10): 32
  2. Kang (2014) J Emerg Trauma Shock 7(3): 239-41 +PMID: 25114438 [PubMed]
  3. Tharaknath (2013) Ann Indian Acad Neurol 16(2): 252-54 +PMID: 23956576 [PubMed]

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