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  • Title: Successful treatment of methemoglobinemia and acute renal failure after indoxacarb poisoning.
    Author: Park JS, Kim H, Lee SW, Min JH.
    Journal: Clin Toxicol (Phila); 2011 Oct; 49(8):744-6. PubMed ID: 21867363.
    Abstract:
    CONTEXT: We report a case of systemic toxicity induced by indoxacarb, an oxadiazine insecticide. Previous reports have suggested the occurrence of methemoglobinemia after indoxacarb ingestion, but no case of indoxacarb-induced systemic toxicity, such as acute renal failure, has been reported thus far. CASE DETAILS: A 71-year-old woman presented with indoxacarb poisoning, resulting in methemoglobinemia and acute renal failure. The methemoglobinemia improved after methylene blue administration, but rapidly progressive acute renal failure occurred 7 h after admission. She was treated with continuous veno-venous hemofiltration and intravenous sodium bicarbonate and recovered successfully. DISCUSSION: Ingestion of indoxacarb may produce not only methemoglobinemia, but also systemic toxicities like acute renal failure, which can be successfully treated with aggressive therapy such as continuous veno-venous hemofiltration. Physicians should be alert to acute renal failure as a possible complication of indoxacarb ingestion, and treat it accordingly.
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