Hemoadsorption in severe abamectin poisoning: a case report

Introduction Abamectin is a macrocyclic lactone pesticide causing central nervous system depression and respiratory or cardiovascular instability. Evidence for extracorporeal treatment, particularly hemoadsorption, remains limited.Case A 62-year-old man with cerebral infarction intentionally ingested 50 mL of 3.6% abamectin pesticide (Reasgant 3.6EC). LC-MS/MS confirmed exposure. Five hours after ingestion, he developed consciousness impairment (GCS 6; E1V1M4), bilateral mydriasis (5 mm), sinus bradycardia, and hypotension (90/60 mmHg), with heart rate reaching 30 beats/min. Atropine and adrenaline were administered. MRI showed chronic cerebral infarction, and echocardiography was normal. Troponin T increased from 27.9 to 44.5 ng/L, while NT-proBNP peaked at 140.2 pg/mL. Hemoadsorption with an MG-350 cartridge was initiated 18 hours after ingestion, using 200 mL/min blood flow, 2–3-hour sessions, heparin anticoagulation, and a cartridge per session for three sessions. GCS improved from 6 to 9, followed by recovery. He was discharged after 10 days without sequelae.Discussion Hemoadsorption may have contributed to improvement, but causality cannot be established because serial abamectin concentrations were not measured. Further studies are warranted.