Dichlorvos poisoning in a pediatric patient: a case report

Introduction: Dichlorvos is an organophosphate compound that is restricted in the United States. Information regarding dichlorvos skin manifestations and pediatric exposures are extremely limited. Case: A nonverbal 15-year-old male with a past medical history of autism spectrum disorder, congenital CMV, and intellectual disability was brought to the emergency department for vomiting. He developed rhinorrhea, blistering skin lesions (on inner thighs), tachypnea, decreasing mental status, and an oxygen requirement. He was started on empiric antibiotics, oxygen, and admitted to the hospital. On hospital day 3, a family member discovered a bottle of “Sniper 1000EC DDVP” insecticide (containing dichlorvos) on a shelf at home with the cap removed and half the product missing. The patient continued to recover and was discharged on hospital day 5. Cholinesterase concentrations sent on hospital day 4 returned with the following values: plasma cholinesterase 0.8 U/mL (ref 2.9 − 7.1) and RBC cholinesterase 2.7 U/mL (ref 7.9 − 17.1). Discussion: Although restricted in the United States, dichlorvos remains a potential source of morbidity. Systemic effects of dichlorvos exposure may be similar to other organophosphate compounds and include vomiting, rhinorrhea, respiratory failure, and decreased mental status. Local effects from dichlorvos or dichlorvos-containing products may lead to chemical burns.