A case of suspected brain death within 24 hours after ingestion of tolfenpyrad and an organophosphorus insecticide.

A 55-year-old man attempted suicide by ingesting tolfenpyrad, emulsion formulation insecticide, and organophosphorus pesticide emulsion, each three gulps. He was found lying on the floor and his family called an ambulance an hour later from ingesting. On arrival at our hospital, his Glasgow Coma Scale score was 14 (E3V5M6), his vital signs were stable, and he was able to converse. Activated charcoal and laxatives were injected through a gastric tube, and continuous administration of pralidoxime iodide was started. After hospitalization, he complained of nausea and his consciousness level decreased immediately. Endotracheal intubation was performed, and mechanical ventilation management was started Subsequently, he experienced bradycardia leading to transient cardiopulmonary arrest. Return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. While blood pressure was stabilized with continuous catecholamine administration, blood gas analysis revealed severe lactic acidosis, which gradually aggravated. Electroencephalography performed 16.5 hours after the suicide attempt showed flat waves, and he wa's suspected brain dead. He died about 37 hours after the suicide attempt.