FATAL METHEMOGLOBINEMIA AND CARDIAC ARREST FOLLOWING INDOXACARB POISONING: A CASE REPORT

Shubamalya L. G.*, Sanivarapu Radhika, R. Roshinee, P. Joanna Grace, Singirikonda Sreesha, P. Deepthi Patel, Aduvala Chaitanya, Dr. S. Tharun Raj, Dr. B. Mounika Bai and Dr. Sumanth Raj Pasunoori

ABSTRACT

Background: Indoxacarb is a widely used oxadiazine insecticide for general use, low in toxicity to humans. Rarely, however, high ingestion produces conditions which can become fatal, e.g., methemoglobinemia. Case Presentation: We report a case of middle-aged male, who entered the emergency department by ingesting the indoxacarb, developed central cyanosis unresponsive to oxygen, chocolate-colored blood, and progressive hypoxia. He underwent supportive management, including high-flow oxygen, gastric decontamination with ascorbic acid, and planned methylene blue therapy (which was unavailable), and later developed pulseless electrical activity and succumbed to cardiac arrest. Conclusion: This highlights methemoglobinemia induced by indoxacarb, and not very frequently described, but may be fatal. It also emphasizes the early clinical recognition, the immediate availability of specific antidotes like methylene blue, and emergency preparedness, which allows improved outcomes for patients.

Keywords: Indoxacarb poisoning, Methemoglobinemia, Cardiac arrest, Methylene blue, Insecticide toxicity, Cyanosis, Toxicology emergency.