Fipronil and Acetamiprid Poisoning: New Perils.

Suicides due to insecticide poisoning represent a major public health concern. Introduction of newer synthetic pesticides like neonicotinoids and fipronil, with novel mechanisms of action, have led to widespread adoption of these in the agriculture industry. They act by altering the neuronal transmission mechanisms in the central nervous system, specifically of the invertebrates, and lead to death of the organism. Though they were perceived to be invertebrate-specific, there have been few case reports of these, leading to notable clinical adverse effects on human exposure. We present a case of acetamiprid and fipronil consumption, who presented to us with central nervous system manifestations and his clinical management. With increasing use of newer pesticides, clinical knowledge regarding the toxic effects of these seems indispensable. How to cite this article: Jayaprakash R, Elangovan A, Nagaraju P. Fipronil and Acetamiprid Poisoning: New Perils. Indian J Crit Care Med 2022;26(4):526-527.

QTc Prolongation in the Critically Ill: Tread with Caution!

How to cite this article: Elangovan A. QTc Prolongation in the Critically Ill: Tread with Caution! Indian J Crit Care Med 2020;24(4):220-221.

Apical ballooning syndrome after attempted suicidal hanging.

We report a case of "Apical Ballooning Syndrome" following attempted suicidal hanging. Our patient developed retrosternal chest pain and ischemic changes on electrocardiography (ECG), a day after the suicidal attempt. She underwent an angiogram considering the possibility of acute coronary syndrome. However, her coronary arteries were normal; the left ventricle showed the typical ballooning pattern characterized by hypokinesia of the distal septum and apex. On follow-up a week later, she remained asymptomatic; her ECG changes had reversed and the left ventricular contractility was normal on echocardiography.

Late onset, prolonged asystole following organophosphate poisoning: a case report.

INTRODUCTION: Organophosphate (OP) compounds are commonly used as suicidal agents and produce characteristic toxic effects. Cardiac arrhythmias are often observed in the acute phase of toxicity; late onset polymorphic ventricular tachycardia preceded by prolonged QT interval on the EKG is also known to occur. However, there are no reports of late onset, prolonged asystole without preceding arrhythmias and after acute toxicity had abated. CASE REPORT: We report a case of prolonged asystole 12 days after ingestion of an OP compound, after apparent recovery from the acute toxic effects. Asystole persisted for 25 min, followed by successful resuscitation without any sequelae. DISCUSSION: Although cardiac arrhythmias and circulatory arrest are known to occur following OP ingestion, these are often in the acute phase of toxicity. Our patient had no preceding cardiac manifestations but developed prolonged refractory asystole after 12 days of ingestion of the compound when the acute effects had subsided. We emphasize the importance of being aware of the potential for OP compounds to cause late onset asystole and the need for continued EKG monitoring even after the acute symptoms appear to have settled.