Abstract

Emamectin benzoate emulsion is a macrocyclic lactone insecticide that is not classified as an organophosphate or carbamate. We report the case of a man in his 80s with chronic kidney disease and cardiovascular comorbidities who ingested emamectin benzoate emulsion. On day 2, he presented with abdominal pain, diarrhea, and marked sialorrhea; his vital signs were stable; however, his serum cholinesterase (ChE) had markedly declined (18 U/L). The patient was discharged with supportive care. From day 3, watery diarrhea recurred and neurobehavioral symptoms progressed. On day 5, he presented with pinhole miosis and further ChE suppression (2 U/L). Therefore, atropine was administered, and the patient was transferred for close monitoring. After discharge (day 8), miosis and sialorrhea persisted, and ChE remained low for weeks. Findings suggestive of tubular injury were observed during follow-up. The patients’ symptoms resolved gradually, with ChE partially recovering by days 75 – 95. This case underscores the need for serial reassessment and structured follow-up after pesticide exposure, even when the patient appears stable at the initial presentation.


Author Details

Authors

• Hideo Chubachi¹
• Noritaka Kitazume¹
• Kenji Momo²
• Haruka Kamagata³

Departments

• ¹ Department of Pharmacy, Shonan-Fujisawa Tokushukai Hospital, Fujisawa-shi, Kanagawa,
• ² Division of Clinical Research, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Hatanodai Shinagawa-ku, and
• ³ Department of Emergency Medicine, Shonan-Fujisawa Tokushukai Hospital, Fujisawa-shi, Kanagawa, Japan

Address

Hideo Chubachi, MD, Department of Pharmacy, Shonan-Fujisawa Tokushukai Hospital, Tsujido-Kandai 1-5-1, Fujisawa-shi, Kanagawa 251-0041, Japan, or Associate Prof. Kenji Momo, PhD, Division of Clinical Research, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo 142-8555, Japan
Email: [email protected]

Citation