Dear Editor,. We report the first case of diabetic ketoa- cidosis (DKA) in a worker recently exposed to high levels of the fungicide chlorothalonil. In April 2011, a ...
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PostScript
LETTER
Diabetic ketoacidosis following chlorothalonil poisoning Dear Editor, We report the first case of diabetic ketoacidosis (DKA) in a worker recently exposed to high levels of the fungicide chlorothalonil. In April 2011, a 56-year-old male farmer was admitted with severe dehydration, hypotension, vomiting and general malaise. Blood tests showed glucose 861 mg/dL (70–110), HbA1c 14.3% (4– 6), pH 7.05 (7.37–7.43) and bicarbonate 3.8 mEq/L (20–24). A urinalysis showed intense ketonuria. A diagnosis of DKA was made. However, the presentation of DKA was unusual; the patient was a healthy man, he had no evidence of prior hyperglycaemia or risk factors for diabetes and type 1 autoantibodies were negative. Since the symptoms suggested an occult noxa we questioned him more thoroughly. Two months before admission, he had been hired to clean a farm shed. Various pesticides were used extensively; however, no protective measures (gloves, clothing or respiratory devices) had been used. Within 3 weeks, the patient developed polyuria, polydipsia and steady weight loss. Six weeks later, a relentless sense of malaise began along with progressive weakness and diffused abdominal pain. When severe vomiting started he went to the emergency room. The patient stated that the pesticides involved were chlorothalonil (2,4,5,6-tetrachloroisophthalonitrile), diuron [3-(3,4dichlorophenyl)-1,1-dimethylurea] and glyphosate [N-(phosphonomethyl)glycine]. Serum chlorothalonil concentrations were found to be 160 ng/mL, while no residues of the other pesticides could be detected (table 1).
Table 1 Pesticide test results (gas chromatography coupled mass spectrometry in tandem mode analysis) Concentration
