Citation

Kamada H, Suzuki H, Yamamoto S, Nomura R, Kushimoto S. Acute Med. Surg. 2017; 4(3): 326-328.

Affiliation

Division of Emergency and Critical Care MedicineTohoku University Graduate School of MedicineSendaiJapan.

Copyright

(Copyright © 2017, Japanese Association for Acute Medicine, Publisher John Wiley and Sons)

DOI

10.1002/ams2.267

PMID

29123883

PMCID

PMC5674463

Abstract

CASE: A 72-year-old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11-54. OUTCOME: Even after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head-up tilt test, and reduction in coefficient of variation of R-R intervals and cardiac iodine-123-metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol.

CONCLUSION: This case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late-onset neurological complications.

Language: en

Keywords

Acetamiprid; autonomic neuropathy; delayed neuropathy; diethylene glycol; poisoning