From the Research
Ingesting blister beetles can cause severe toxicity due to cantharidin, a potent vesicant, and management is primarily supportive with no specific antidote, focusing on decontamination, intravenous fluid resuscitation, and symptomatic treatment. Symptoms typically appear within hours and include:
- Burning pain in the mouth, throat, and abdomen
- Difficulty swallowing
- Excessive salivation
- Nausea
- Bloody vomiting
- Diarrhea Severe cases may progress to:
- Hematemesis
- Hematuria
- Acute kidney injury
- Cardiac abnormalities
- Shock Treatment begins with decontamination if the patient presents early; activated charcoal (1 g/kg orally) may be given if within one hour of ingestion 1. Intravenous fluid resuscitation is crucial to prevent kidney damage. Symptomatic treatment includes:
- Pain management with opioids as needed
- Antiemetics for vomiting
- Proton pump inhibitors for GI protection Cardiac and renal function should be monitored closely, with particular attention to electrolyte abnormalities, as cantharidin damages cell membranes, causing blistering of tissues and disruption of renal tubular function 2. Severe cases may require intensive care for hemodynamic support, and hemodialysis might be necessary for significant renal failure. Patients should be observed for at least 24 hours, as complications can develop later. The most recent study on cantharidin poisoning highlights the importance of early recognition and treatment to prevent long-term damage 1.
The signs and symptoms of cantharidin poisoning can be recognized by a history of alfalfa feeding, with colic, dysuria, hypocalcemia, and hypomagnesemia, and tentative diagnosis can be made by finding the beetles in feed or ingesta 1. Definitive diagnosis requires detection of cantharidin in urine or gastric contents. The prognosis is guarded to poor, emphasizing the need for prompt and effective management.
In clinical practice, it is essential to be aware of the potential for cantharidin poisoning, especially in areas where blister beetles are common, and to educate patients about the risks of ingesting these insects 3, 4. By prioritizing supportive care and monitoring for potential complications, healthcare providers can improve outcomes for patients with cantharidin poisoning.