Available online on 15.08.2021 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2021 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                                                         Case Report 

A Case Report of Fungicial Poisoning

Uma Malaika Rapolu*, Nabeela Tarannum, Enara Bawani, Mohd Danish

Department of Pharmacy, Turkayamjal, Hyderabad, Telangana 501510, India

INTRODUCTION

Myclobutanil may be a conazole class fungicide. Mostly employed in food crops (like apple, banana, asparagus, beans, cranberry, grape, plum, soybean, tomato, strawberry) and in other commercial landscape. Moreover it’s lower acute toxicity is seen. In animal study, it can affect reproductive ability. Workers in fields are mostly affected. Common symptoms include headache, eye irritation, itching, nausea, vomiting, abdominal pain, nose bleeding.   Myclobutanil can effect heart (heart rhythm, hypovolemia, hypotension), systema respiratorium (pulmonary edema, bronchospasm), and seizures also are seen. Treatment involves establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Sit up for signs of respiratory insufficiency and assist ventilations if needed. Administer oxygen by nonrebreather mask at 10 to fifteen L/min. Monitor for pulmonary edema and treat if necessary. Monitor for shock and treat if necessary. ¹

Anticipate seizures and treat if necessary. For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport .²

Don’t use emetics. For ingestion, rinse mouth and administer 5 ml/kg up to 200 ml of water for dilution if the patient can swallow, includes a strong instinctive reflex, and doesn't drool. Cover skin burns with dry sterile dressings after decontamination.³

Consider orotracheal or nasotracheal intubation for airway control within the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device could also be beneficial. Consider drug therapy for pulmonary edema. Consider administering a beta agonist like albuterol for severe bronchospasm. Monitor heart rhythm and treat arrhythmias as necessary. Use 0.9% saline (NS) or lactated Ringer’s if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. look ahead to signs of fluid overload. ⁴

Treat seizures with diazepam or lorazepam . Use proparacaine hydrochloride to help eye irrigation 

CASE REPORT

A 39 years old male patient who was an occasional ethanolic was remarked to the emergency department with complaint nausea, vomiting, seizures, loss of consciousness and nose bleeding in sight over consumption of mycobutanil poison

Upon admission into general medical aid unit the vitals were, Temp: 98.6ºF  BP:120/90mmHg   PR:88 bpm RR:18bpm No crepts 

Laboratory investigation

Upon further investigations  the patient had a standard haematological   levels, serum electrolytes levels, on contrary  the hepatic function test showed increase in total bilirubin, direct and indirect bilirubin and  more over the ECG was abnormal which showed  abnormal Sinus rhythm, Left atrial enlargement, R-S transition zone in v leads displaced to right. 

Differential diagnosis:- 

The patient was diagnosed by the history interrogation with patient’s attenders and also the symptoms of fungicide poisoning like loss of consciousness, five episodes of vomiting and one episode of seizure and abnormal ECG supported above investigations and interrogation the patient was diagnosed with victim of mycobutanil poisoning 

Treatment:- 

Upon admission the patient as there's not particular antidote the patient was firstly secured with dextrose normal saline and ringer lactate solutions for stability later the treatment was started with broad spectrum antibiotics, diazepam, proton pump inhibitors, ondansetron and cynacoblamine. 

The patient was monitored and  treated for 6 days and later was discharged with proper counselling to the patient and family with discharge medication plan  which  was comprised of cephalosporin antibiotic , multi vitamins, proton pump inhibitors and calcium supplementation .The patient came with  complaint  vomiting, seizures, loss of consciousness visible  over consumption of mycobutanil  poison

DISCUSSION

Myclobutanil may be a conazole class fungicide. Mostly workers in food crops and commercial landscape are affected. Myclobutanil poisoning is quite rare. Common symptoms include headache, eye irritation, itching, nausea, vomiting, abdominal pain, nose bleeding.  Myclobutanil can effect cardiovascular sytem( heart rhythm, hypovolemia, hypotension), systema respiratorium ( pulmonary edema, bronchospasm), and seizures also are seen

 Patient was brought to the emergency department with chief complaint nausea, nose bleeding, vomiting, seizures, loss of consciousness in view over consumption of mycobutanil poison.

As there's no definite antidote for fungicide poisoning   the patient was secured with intravenous saline and broad spectrum antibiotics , proton pump inhibitors and was monitored and treated for 4 days  , later was discharged with proper counselling to patient and patients attenders for a healthy socio-family life, cessation of alcohol , discharge medication plan which encompassed of multivitamins and calcium supplementations. 

REFERENCES

1.    Profenofos | C11H15BrClO3PS - PubChem [Internet].Available from: https://pubchem.ncbi.nlm.nih.gov/compound/profenofos

2.    Sodium Fluoride - Key Info [Internet]. Available from: https://webwiser.nlm.nih.gov/substance?substanceId=464

3.    Non-Rebreather Mask - an overview | ScienceDirect Topics [Internet]. Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/non-rebreather-mask

4.    Myclobutanil | C15H17ClN4 - PubChem [Internet]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Myclobutanil