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Emamectin is a macrocyclic lactone-ring insecticide widely used on various vegetable crops and fruits. Emamectin acts through high-affinity gamma-aminobutyric acid (GABA) receptors by increasing the chloride permeability, thus causing muscle paralysis in invertebrates. Here we report a fatal case of intentional ingestion of emamectin in an adult. A 53-year-old male presented to the emergency department with an alleged history of suicidal ingestion of emamectin benzoate 5% water soluble granules mixed with around 180ml of ethyl alcohol following which he developed vomiting and was immediately taken to a nearby hospital. Gastric lavage was performed; however, he succumbed to death the following day. The autopsy examination showed evidence of stomach mucosal erosions, alveolar oedema, and hepatic necrosis. Chemical analysis of viscera detected qualitatively the presence of emamectin benzoate in blood and tissues. Toxicological analysis of emamectin and its potential limitations was discussed. Death following emamectin poisoning in humans has been reported very little in the literature due to which its spectrum of clinical features is difficult to comment upon. Future case studies and literature will help better understand the range of clinical and autopsy features to aid the prompt diagnosis.
Vikram et al. (Tue,) studied this question.