What is the management for All Out (N,N-diethyl-meta-toluamide) mosquito repellent poisoning?

Management of All Out (DEET) Mosquito Repellent Poisoning

The management of N,N-diethyl-meta-toluamide (DEET) mosquito repellent poisoning should focus on supportive care with particular attention to respiratory complications, as most cases present with aspiration pneumonitis rather than neurological complications.

Clinical Presentation

• DEET poisoning can occur through ingestion, skin absorption, or inhalation, with children being particularly vulnerable to accidental ingestion 1
• Symptoms typically present within hours of exposure and may include respiratory distress, central nervous system effects, and dermatitis 2, 3
• Severe toxicity can occur with high concentration products (>50% DEET), with inhalational exposure being particularly dangerous 2

Initial Management

• Ensure airway, breathing, and circulation are stabilized 1
• Remove contaminated clothing and wash exposed skin thoroughly with soap and water 3
• For ingestion cases:
  • Do not induce vomiting due to aspiration risk from hydrocarbon content 1
  • Consider activated charcoal only if presentation is within 1 hour of ingestion and airway is protected 3

Respiratory Management

• Closely monitor for development of Acute Respiratory Distress Syndrome (ARDS), which occurs in up to 70% of liquid mosquito repellent ingestion cases 1
• Provide supplemental oxygen for mild-moderate respiratory distress 1
• Consider positive airway pressure support for moderate-severe respiratory distress 1
• Be prepared for mechanical ventilation in severe cases with significant respiratory compromise 1

Neurological Management

• Monitor for neurological complications including seizures, toxic encephalopathy, and acute manic psychosis 3
• Treat seizures with standard anticonvulsant therapy if they occur 3
• Consider EEG monitoring in patients with altered mental status 2

Cardiovascular Monitoring

• Monitor vital signs and cardiac rhythm due to potential cardiovascular toxicity 3
• Treat hypotension with IV fluids; vasopressors may be required in severe cases 2

Laboratory Investigations

• Complete blood count, electrolytes, renal and liver function tests 1
• Arterial blood gas analysis in patients with respiratory symptoms 1
• Chest radiography to assess for pneumonitis or ARDS 1

Specific Considerations

• The average duration of respiratory support required is approximately 3.3 days in pediatric cases 1
• Prognosis is generally good with appropriate supportive care, with most patients surviving with complete recovery 1
• Monitor for potential drug interactions, as DEET may compete in metabolism with other compounds, altering their biodistribution 3

Prevention Strategies

• Store mosquito repellents in child-proof containers out of reach of children 1
• Do not exceed manufacturer's recommendations for application, particularly with small children 4
• Use lower concentration DEET products (concentration <50%) for routine use 4
• Consider alternative mosquito protection methods such as permethrin-treated clothing in combination with topical repellents for safer, effective protection 5, 6

Follow-up Care

• Arrange follow-up to assess for any delayed complications, particularly respiratory or neurological 1
• Provide education on safe use of insect repellents to prevent future incidents 4
• Report cases to poison control centers to improve surveillance and prevention strategies 1