Context: Pesticide exposures are common health issues in India. Traditionally used pesticides like organophosphates are associated with higher morbidity and mortality. Neonicotinoids are newer class of effective and safer insecticides. However, literature of human exposures is very limited. Aims: To study clinical profile, laboratory features and factors associated with mortality after acute human neonicotinoid exposures. Settings and Design: This retrospective observational study was performed at department of general medicine in rural tertiary care public hospital. Methods and Material: Necessary data of admitted eligible cases of acute neonicotinoid poisoning during five year period of January 2012 to December 2016 were retrieved from medical record section and were analysed. Statistical Analysis: Statistical analyses were performed by using Graph pad prism 5. The incidence of Clinical findings, 95% confidence interval, relative risk, and baseline characteristics of patients were calculated by Wilcoxon rank sum test and chi square test. Statistical significance was established at p < 0.05 and RR values were considered statistically significant if 95% of CI excluded 1%. Results: A total of 141 cases were analyzed. Most exposures involved oral intentional consumptions of Imidacloprid. Clinical manifestations of acute neonicotinoids exposures involved variety of body systems. Severe/fatal cases had higher proportion of respiratory, neurological and cardiovascular manifestations and variety of laboratory and ECG finding. Although most exposures were asymptomatic or nonsevere poisoning, 26 cases had severe poisoning with five deaths. Conclusions: Even though considered as relatively safer insecticides, large intentional consumption can lead to severe poisoning and even death. Supportive treatment is usually sufficient and severe poisoning needs intensive case.

Keywords: Imidacloprid; Insecticide; Neonicotinoid; Poisoning.