Piperonylbutoxide as a Dubious Cause of Cardiac Manifestations in Pyrethroid Insecticide Poisoning; a Letter to Editor
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 November 2022
There is little evidence regarding pyrethroid poisoning manifesting with cardiac problems in the literature. Many authors, however, adopted that pyrethroids have a direct effect on heart tissue and can cause cardiotoxicity. Interestingly, no experimental studies have yet determined its mechanism of toxicity on cardiac muscle cells. This letter aims to describe the probable cause of clinical manifestations attributed to piperonylbutoxide, an ignored ingredient in pesticide poisoning, which is added to many pesticide products to increase their insecticidal potency. We think that cardiac manifestations in some cases of pyrethroid poisoning are due to the concomitant piperonylbutoxide toxicity and its possible effect on norepinephrine release from adrenal gland, which might explain changes in cardiac findings. Thus, it is necessary for all clinical toxicologists to determine suspicious ingredients when they are facing a doubtful manifestation.
How to Cite
Habedank D, Stubbe B, Ewert R, Kroll A, Atmowihardjo I, Habedank B. Inhalation of publicly available indoor insecticide spray caused myocardial infarction type II: a case report. ESC Heart Fail. 2021;8(4):3403-7.
Shilpakar O, Karki B. Cypermethrin poisoning manifesting with prolonged bradycardia: A case report. Toxicol rep. 2021;8:10-2.
Alexandri M, Spaeth KR. Nontransient third‐degree heart block and persistent respiratory findings as sequelae of acute occupational exposure to pyrethroids insecticide. Am J Ind Med. 2020;63(7):644-8.
Bhaskar EM, Moorthy S, Ganeshwala G, Abraham G. Cardiac conduction disturbance due to prallethrin (pyrethroid) poisoning. J Med Toxicol. 2010;6(1):27-30.
Singh H, Luni FK, Marwaha B, Ali SS, Alo M. Transient complete heart block secondary to bed bug insecticide: a case of pyrethroid cardiac toxicity. Cardiology. 2016;135(3):160-3.
Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank's toxicologic emergencies. 10th ed: McGraw-Hill New York; 2014.
Babić G, Jović-Stošić J, Todorović V, Kosanović M, Janković S. Cardiotoxicity of piperonyl-butoxide: a case report. Pesticidi. 2000;15(4):297-300.
Walters JK, Boswell LE, Green MK, Heumann MA, Karam LE, Morrissey BF, et al. Pyrethrin and pyrethroid illnesses in the Pacific northwest: a five-year review. Public Health Rep. 2009;124(1):149-59.
Jeyaratnam J, Forshaw P. A study of the cardiac effects of DDT in laboratory animals. Bull World Health Organ. 1974;51(5):531.
Krieger R, Krieger WC. Handbook of pesticide toxicology. Massachusetts: Academic press; 2001.
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