A 3-year-old boy presented with complaints of sudden onset vomiting and difficult breathing following accidental ingestion of a liquid mosquito repellent vaporizer (LMRV). He was alert, respiratory rate was 54/min, and there were subcostal, intercostal retractions, nasal flaring, and fine crepitations over right lower chest. Arterial blood gas was normal on 6 L/min of inhaled oxygen. Chest radiograph done after 6 hours, showed pneumonitis in right middle and lower zones. He improved over 48 hours without antibiotics.

The use of LMRV is common in setting of infections like malaria and dengue. These products contain derivatives of pyrethrins as mosquito repellent and kerosene as the solvent. Pyrethrins have poor dermal absorption and rapid metabolism. Popular brands use 0.88% of the chemical, that was transfluthrin in the present case. Toxicity results mainly in central nervous system (CNS) symptoms like headached, dizziness, drowsiness, status epilepticus and respiratory failure. These chemicals act by prolonging the opening of sodium channels leading to increased influx of sodium ions and thus hyper-excitation of the nervous system [1]. Cardiac dysfunction has also been described, but lung injury is not commonly reported [2,3].

The poisoning of the second component of LMRV –kerosene – is well recognized. Being highly volatile and less viscous, it can cause life threatening lung injury in the form of aspiration pneumonitis and ARDS. Chest radiograph may be normal initially and abnormalities like fine perihilar opacities, basilar infiltrates, and atelectasis may appear after some hours of ingestion. The use of LMRV increases the risk of kerosene poisoning even in setting where it is not used as fuel. We emphasize that LMRV poisoning should be treated as kerosene poisoning with supportive and symptomatic management and recommend that use of household LMRV should be recognized and listed as a risk factor in the etiology of kerosene poisoning.

1. Panwar M, Usha G, Kumath M. Status epilepticus: an association with pyrethroid poisoning. Indian J Crit Care Med. 2013;17:119-20.

2. Bhaskar EM, Moorthy S, Ganeshwala G, Abraham G. Cardiac conduction disturbance due to prallethrin (pyrethroid) poisoning. J Med Toxicol. 2010;6:27-30.