Management of Azadirachtin 2% Poisoning
Contact a poison control center immediately (1-800-222-1222 in the United States) for expert guidance, as azadirachtin poisoning is rare and requires specialized toxicological consultation. 1
Immediate Priorities
Supportive care takes absolute priority over identification of the specific toxin or antidotal therapy. 1 The management approach focuses on:
- Airway management and respiratory support - Azadirachtin can cause neurotoxicity requiring mechanical ventilation based on documented human case reports 2
- Hemodynamic monitoring and support - Maintain cardiovascular stability as part of essential supportive care 1
- Correction of critical vital sign and metabolic derangements - Address any abnormalities immediately 1
Decontamination
- Remove all contaminated clothing and thoroughly wash exposed skin with soap and water to prevent continued absorption 3
- Healthcare providers must use appropriate personal protective equipment to prevent secondary contamination 4
- Do not induce vomiting as this may worsen the condition and delay definitive care 3
- Do not administer activated charcoal unless specifically advised by poison control - the benefit is uncertain and should only be given under expert guidance 3
Neurological Management
The primary concern with azadirachtin poisoning is neurotoxicity:
- Administer benzodiazepines (diazepam or midazolam) for seizures or agitation if they occur 1, 5
- Monitor closely for altered mental status and CNS depression - one documented case required intensive care with mechanical ventilation for neurotoxic effects 2
Monitoring Requirements
- Observe for at least 48-72 hours even in apparently stable patients - delayed effects may occur 4
- Monitor respiratory function continuously given the documented risk of respiratory failure requiring ventilation 2
- Serial neurological assessments to detect progression of neurotoxicity 2
Critical Pitfalls to Avoid
- Do not delay treatment while waiting for confirmation of azadirachtin poisoning - treat based on clinical presentation and history of exposure 3
- Do not use neuromuscular blockers without adequate sedation if intubation is required, as they can mask seizure activity without treating it 5
- Do not assume safety based on the "natural" origin - despite being a botanical pesticide, azadirachtin has caused severe neurotoxicity requiring intensive care in documented human poisoning 2
Prognosis
The single documented case of deliberate azadirachtin overdose in an adult resulted in survival with no long-lasting side effects after intensive supportive care, suggesting good outcomes are possible with appropriate management 2