Diagnosis by nose.
Article Type: Editorial
Subject: Poisoning (Diagnosis)
Poisoning (Care and treatment)
Amitraz (Complications and side effects)
Diagnosis (Methods)
Pub Date: 04/01/2012
Publication: Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 South African Medical Association ISSN: 0256-9574
Issue: Date: April, 2012 Source Volume: 102 Source Issue: 4
Product: Product Code: 8000420 Diagnostic Procedures NAICS Code: 6215 Medical and Diagnostic Laboratories
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 286392536
Full Text: In an era where a patient's medical history and physical examination may play second fiddle to a battery of biochemical and imaging tests, Parrish and Lancaster (2) refreshingly return to basics and provide an olfactory diagnostic clue.

Amitraz is an agricultural insecticide and veterinary pesticide used to treat ectoparasite infections in animals. Human poisoning may be accidental or deliberate. The initial clinical presentation of amitraz and organophosphate poisoning may be similar; however, their management is different. Patients present with nausea, vomiting, bradycardia, and either miosis or mydriasis. Reduced serum pseudocholinesterase supports a diagnosis of organophosphate toxicity, but there is no similar laboratory test for amitraz poisoning. Amitraz and its metabolites or solvents may contribute to a characteristic 'mothball-like' or 'dry-cleaning' odour in the poisoned patient, which is often particularly noticeable on endotracheal suctioning.

The authors, in a blinded trial, tested 23 volunteer healthcare workers on their ability to distinguish between the odours of amitraz, organophosphate and distilled water; 83% were able to distinguish between these odours. They conclude that this simple component of bedside examination may allow earlier recognition of this potentially fatal poisoning. Severely ill patients should receive prompt vigorous resuscitation and support.
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