Treatment of Cypermethrin Poisoning in Children
The treatment for cypermethrin (pyrethroid insecticide) poisoning in children is primarily supportive care with decontamination, monitoring, and symptom management, as there is no specific antidote for pyrethroid toxicity. 1
Initial Management
- Decontamination: Remove contaminated clothing and thoroughly wash exposed skin with soap and water to prevent further absorption 1
- Airway management: Secure airway, breathing, and circulation; intubation may be necessary in severe cases with respiratory depression 1, 2
- Gastric decontamination: Consider activated charcoal if the patient presents within 1 hour of ingestion and has a protected airway 1
- Avoid inducing vomiting as this may increase risk of aspiration 1
Symptomatic Treatment
Neurological Symptoms
- Seizures: Treat with benzodiazepines (diazepam or lorazepam) as first-line therapy 3
- Muscle fasciculations/tremors: Benzodiazepines may help control these symptoms 1, 3
Cardiovascular Symptoms
- Bradycardia: Low-dose atropine sulfate may be used if significant bradycardia is present 4
- Hypotension: IV fluids for support; vasopressors if needed for persistent hypotension 2
Respiratory Support
- Oxygen supplementation as needed 2
- Mechanical ventilation for respiratory failure, which occurs in severe cases 1, 2
Monitoring
- Vital signs: Continuous monitoring of heart rate, blood pressure, respiratory rate, and oxygen saturation 4, 2
- Laboratory tests: Complete blood count, electrolytes, liver and kidney function tests 2
- ECG monitoring: For cardiac abnormalities, particularly bradycardia 4
Special Considerations for Children
- Weight-based dosing: All medications should be carefully dosed based on the child's weight 5
- Fluid management: More careful monitoring of fluid status due to children's lower body mass 2
- Temperature regulation: Children may be more susceptible to hypothermia or hyperthermia 5
Pitfalls and Caveats
- Misdiagnosis as organophosphate poisoning: Cypermethrin can present with an organophosphate-like toxidrome, leading to inappropriate high-dose atropine administration 1
- Excessive atropine: If atropine is used for bradycardia, use lower doses than would be used for organophosphate poisoning 1, 4
- Delayed symptoms: Some neurological effects may appear hours after exposure 3
- Combined exposures: Be alert for mixed pesticide exposures (e.g., cypermethrin with organophosphates), which may have synergistic toxicity 2
Prognosis
- Most children with mild to moderate cypermethrin poisoning recover completely with supportive care 1
- Severe poisoning with respiratory failure has higher morbidity but mortality remains relatively low compared to other pesticide poisonings 2
- Long-term neurological follow-up may be warranted in severe cases due to potential for delayed neurotoxicity 3, 5