ArticleToxicology reports2026
Toxicokinetics under extracorporeal clearance and temporal dissociation of hepatotoxicity and coagulopathy in ACDMB poisoning: Two index cases.
Article in Toxicology reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 2-Amino-5-chloro-N,3-dimethylbenzamide (ACDMB), a synthetic intermediate for the insecticide chlorantraniliprole, causes extremely rare occupational poisoning (six cases worldwide) with unknown human toxicokinetics. We report two consecutive index cases from the same manufacturing facility.Case presentationCase A (22-year-old male) and Case B (37-year-old male) developed fulminant hepatitis following brief accidental occupational exposure. Both received plasma exchange and continuous venovenous hemofiltration; Case A additionally received hemoperfusion. Both achieved full recovery and were discharged on Day 28 (Case A) and Day 14 (Case B), respectively. Results: Serial serum monitoring in Case B revealed mono-exponential elimination (apparent half-life 18.4 h, 95% CI 15.3-22.1). Both patients exhibited temporal dissociation: peak hepatotoxicity occurred at 54-65 h, whereas critical coagulopathy (Coagulation Reserve Index [CRI] <5) developed later at 123-127 h when > 95% of toxin had been cleared. At comparable CRI nadirs, hemoperfusion in Case A resulted in immediate circuit clotting and prolonged DIC reversal (48 h), whereas cryoprecipitate support in Case B achieved rapid recovery (8.3 h) without adsorptive therapy. Conclusion: These observations provide the first human ACDMB toxicokinetic profile under extracorporeal clearance and generate the hypothesis that CRI < 5 may identify high-risk periods for hemoperfusion, though prospective validation is required.
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