Avermectin poisoning with panic-like symptoms: a case series
4 affiliations
- 1Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- 2Shandong University Hospital, Shandong University, Jinan, Shandong, China
- 3First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- 4Department of Geriatric Medicine, Department of Nursing, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
Abstract
BackgroundHigh doses of avermectin, a macrolide derived from Streptomyces avermitilis, can cause coma, delirium, respiratory failure, hypotension, and acidosis. However, certain adverse toxicological effects and psychological implications remain unrecognized in patients undergoing parasuicide.Case PresentationCase 1: A 54-year-old man ingested approximately 500 mL avermectin benzylate. He was found to be somnolent 45 min later. Subsequently, the patient became unconscious with respiratory failure, hypotension, and acidosis (lactate, 16.2 mmol/L). Gastric lavage, mechanical ventilation, hemoperfusion, hemofiltration, and symptomatic treatments were administered. Three days after ingestion, the patient’s primary symptoms were delirium and myoclonus, with a blood avermectin level of 110.06 μg/L. Thereafter, intermittent shaking, limb flexion, and muscle rigidity persisted. Thirteen days after ingestion, brain magnetic resonance imaging was unremarkable. Electroencephalography revealed no epileptiform discharges. After psychiatric evaluation, the patient was assessed as having panic-like symptoms, and his symptoms improved significantly with specialized treatment. Case 2: A 33-year-old man was injected with approximately 5 mL of 1% avermectin in his left forearm. Two days later, he reported significant pain and swelling along with intermittent palpitations, dizziness, and limb tremors consistent with panic-like symptoms. His blood avermectin level was 0.02 μg/mL. After 7 days of treatment, the swelling subsided, and the panic-like symptoms resolved.ConclusionAvermectin poisoning causes significant toxic effects, including respiratory failure, hypotension, acidosis, coma, and delirium. Intramuscular injections may result in localized swelling. Parasuicide patients may also present with panic-like symptoms requiring careful differential diagnosis.
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BibTeX
@article{lv2026avermectin,
title = {{Avermectin poisoning with panic-like symptoms: a case series}},
author = {Shizhen Lv and Zhongchen Zhang and Guangcai Yu and Guangcai Yu and Baotian Kan and Baotian Kan and Xiangdong Jian},
journal = {Frontiers in Toxicology},
year = {2026},
month = oct,
doi = {10.3389/ftox.2026.1888317},
url = {https://doi.org/10.3389/ftox.2026.1888317},
note = {CC BY},
}
RIS
TY - JOUR
TI - Avermectin poisoning with panic-like symptoms: a case series
AU - Shizhen Lv
AU - Zhongchen Zhang
AU - Guangcai Yu
AU - Guangcai Yu
AU - Baotian Kan
AU - Baotian Kan
AU - Xiangdong Jian
PY - 2026
DA - 2026/10/25
JO - Frontiers in Toxicology
DO - 10.3389/ftox.2026.1888317
UR - https://doi.org/10.3389/ftox.2026.1888317
AB - BackgroundHigh doses of avermectin, a macrolide derived from Streptomyces avermitilis, can cause coma, delirium, respiratory failure, hypotension, and acidosis. However, certain adverse toxicological effects and psychological implications remain unrecognized in patients undergoing parasuicide.Case PresentationCase 1: A 54-year-old man ingested approximately 500 mL avermectin benzylate. He was found to be somnolent 45 min later. Subsequently, the patient became unconscious with respiratory failure, hypotension, and acidosis (lactate, 16.2 mmol/L). Gastric lavage, mechanical ventilation, hemoperfusion, hemofiltration, and symptomatic treatments were administered. Three days after ingestion, the patient’s primary symptoms were delirium and myoclonus, with a blood avermectin level of 110.06 μg/L. Thereafter, intermittent shaking, limb flexion, and muscle rigidity persisted. Thirteen days after ingestion, brain magnetic resonance imaging was unremarkable. Electroencephalography revealed no epileptiform discharges. After psychiatric evaluation, the patient was assessed as having panic-like symptoms, and his symptoms improved significantly with specialized treatment. Case 2: A 33-year-old man was injected with approximately 5 mL of 1% avermectin in his left forearm. Two days later, he reported significant pain and swelling along with intermittent palpitations, dizziness, and limb tremors consistent with panic-like symptoms. His blood avermectin level was 0.02 μg/mL. After 7 days of treatment, the swelling subsided, and the panic-like symptoms resolved.ConclusionAvermectin poisoning causes significant toxic effects, including respiratory failure, hypotension, acidosis, coma, and delirium. Intramuscular injections may result in localized swelling. Parasuicide patients may also present with panic-like symptoms requiring careful differential diagnosis.
SN - 2673-3080
ER -