Nitrofen has been banned in Taiwan since January 1, 1983 due to its tetrogenicity. A 78-y-o female consumed about 500 ml of
herbicide, labeled as
nitrofen, in a suicide attempt. Consciousness disturbance occurred immediately. After 9 h, bloody-tarry stool was noted.
Hematemesis occurred 19 h later. Hepatotoxicity and nephrotoxicity also developed. Twitching of head and both upper extremities lasting 20-30 sec and up to 5 min developed on day 3. Sometimes an upward gaze with the face turned to the right or a convulsion of the right upper extremity was observed. EEG showed alpha
coma, generalized slow spike-and-wave complexes, and isolated generalized sharp waves mainly in the left occipital area. On day 7, endotracheal intubation was performed due to
apnea; she expired on day 9. The
pesticide was found to contain
butachlor and
chlornitrofen. The Agricultural Committee prohibited the marketing of
chlornitrofen due to its generation of
tumors in animals. The combination of
butachlor and
chlornitrofen can result in consciousness disturbance, leucocytosis,
gastrointestinal hemorrhage,
rhabdomyolysis,
hypocalcemia,
hypoalbuminemia, elevated
amylase, nephrotoxicity, hepatotoxicity,
seizures and death. The cytotoxicity of
butachlor may be related to the patient's death. Active components of pesticides should be checked if the
clinical course of a poisoned patient is unusual to allow appropriate interventions.