Intravenous indoxacarb toxicity: A rare case of unusual exposure with clinical implications

Abstract

A 25-year-old male farmer presented to the emergency department with confusion, cyanosis, and low oxygen saturation (SpO₂) after an intentional intravenous injection of indoxacarb. Initial laboratory tests revealed severe methemoglobinemia (40.8 %), hypokalemia, hyponatremia, leukocytosis, and coagulation abnormalities. Despite supplemental oxygen, SpO₂ remained low, prompting Intensive Care Unit (ICU) admission. Methylene blue (2 mg/kg IV loading dose, followed by 1 mg/kg after one hour) was administered to reduce methemoglobin levels, which decreased to 2 % within six hours, leading to significant clinical improvement. By the second day, the patient’s symptoms resolved, and SpO₂ stabilized at 96 % on room air. Following stabilization, he was transferred to the toxicology ward in good condition. This case highlights clinical presentation, management, and rapid recovery in an instance of intravenous indoxacarb poisoning.