Acute rotenone poisoning: A scoping review.
Level 4 - case-series / case-control
Scoping review summarizing individual case reports
PubMed 38633629 · doi:10.1016/j.heliyon.2024.e28334
What was done
Authors conducted a scoping review across five databases from inception to July 12, 2022, searching for English-language, peer-reviewed reports on human acute rotenone exposure. From 2,631 initial records, they abstracted data on patient demographics, exposure context, estimated doses, clinical features, supportive treatments, and clinical outcomes.
What was found
The review identified 11 case reports describing 18 victims. Of these 18 individuals, 15 were hospitalized and 5 died. Most poisonings occurred in private settings from unknowingly consuming rotenone-containing plants. The most common clinical presentations were vomiting and metabolic acidosis, with some patients developing cardiopulmonary impairment. Management was supportive and included gastric lavage or activated charcoal, vasopressors, mechanical ventilation, sodium bicarbonate, and N-acetylcysteine.
Why it matters
Rotenone is a naturally occurring mitochondrial complex I inhibitor with no specific antidote. This synthesis aggregates sparse clinical data to define the typical presentation of severe metabolic acidosis and gastrointestinal distress and documents common supportive interventions.
Limits
The findings are limited to a small sample size of 18 cases drawn entirely from descriptive case reports without standardized reporting or verified toxic doses. Restricting inclusion to English-language publications likely excluded relevant cases from non-English speaking countries where rotenone exposures predominantly occur.
Cited by
- supports The pesticide rotenone specifically targets and impairs mitochondrial functioning.