PEER REVIEWED abstracts on DEET-- used widely on humans and animals

[Guest guest]

See the peer reviewed abstracts below on serious complications such as

toxic encephalopathy and deaths from use of DEET --most often seen in

children. Adult cases are also cited. Although these cases may be

rare, one almost never sees possible complications such as these

reported in the press or cited by government agencies.

Of great concern to health advocates are the secrecy and misleading

terms given to the unknown ingredients in products, often called

" inert " ingredient, " other " ingredients, or " other compounds " , that

are often toxic. Manufacturers argue that secrecy is necessary to

protect product trade secrets. Health advocates say this argument is

specious due to patent protections and to readily available

reverse-engineering technologies that make it possible for

competitiors to determine the chemical makeup of any product.

Not just consumers are worried about secret ingredients. Medical

emergency teams lose precious time trying to determine what other

chemicals are involved in a given exposure. Look at the last entry

below the peer reviewed abstracts on DEET, under the heading

" Emergency Medical Treatment " and note that the chemicals in DEET

products, referred to as " OTHER COMPOUNDS " , may play an important role

in toxic effects seen in emergency health situations. A. Hotz

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Selected peer reviewed articles below were found at:

http://toxnet.nlm.nih.gov/

click on HSDB, search word <DEET>

DEET

CASRN: 134-62-3

For other data, click on the Table of Contents

Human Toxicity Excerpts :

Several cases of a deet-associated toxic encephalopathy have been

reported in young females. A 3.5 year old girl suffered a bizarre

illness after all of a 180 ml aerosol can of deet had been used each

evening for 2 weeks to spray her and her night clothes and bedding.

Because of this exposure and because careful medical examination

failed to suggest any other cause, the possibility was considered that

deet was the cause. However, it was pointed out that, even if the

child had absorbed all of the deet discharged from the aerosol can,

the dosage of active e ingredient would have been only 0.14 ml/kg/day,

a level tolerated by animals. The signs were disorientation,

staggering gait, slurred speech, and episodes consisting of stiffening

into a sitting position, crying out, extending the extremities,

flexing the fingers, and dorsiflexing the toes. Therapy, which began 1

day after onset, was symptomatic. Recovery was complete in 4 days.

[, W.J., Jr., E.R. Laws, Jr., (eds.). Handbook of Pesticide

Toxicology. Volume 3. Classes of Pesticides. New York, NY: Academic

Press, Inc., 1991. 1503]**PEER REVIEWED**

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A five-yr-old girl, sprayed with DEET nightly for three months,

developed headaches and slurred speech, progressing to athetosis,

shaking, screaming, and convulsions. She died 24 days after

hospitalization. At autopsy the brain showed generalized edema with

intense congestion of meninges. There was no demyelination and no

evidence of meningitis. An 18-mo-old child who ingested an unknown

quantity of a liquid prepn of DEET exhibited similar signs and

symptoms but eventually recovered.

[Gosselin, R.E., R.P. , H.C. Hodge. Clinical Toxicology of

Commercial Products. 5th ed. Baltimore: and Wilkins, 1984.,p.

II-346]**PEER REVIEWED**

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Seizures and acute behavior change developed in an 8 yr old girl

following exposure to Muskol and Off insect repellents. She recovered

within 3 days with supportive treatment; including anticonvulsant

(phenytoin) medication. The assumed toxic agent was

N,N-diethyltoluamide.

[Roland EH et al; Can Med Assoc J 132 (2): 155-56 (1985)]**PEER

REVIEWED**

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General -- covers both adults and children (heading added):

Manifestation of toxic encephalopathy have been behavioral disorders

including headache, restlessness, crying spells, mania, stupor

progressing to coma, ataxia, hyperreflexia, tachypnea, hypotension,

tremors, and writhing convulsions (athetosis). Some cases have shown

flaccid paralysis and areflexia. Deaths have occurred following very

large doses. Blood levels of DEET found in fatal systemic poisonings

have ranged from 168 to 240 mg/l. Interpretation of DEET toxicity in

some fatal cases has been complicated by effects of simultaneously

ingested ethanol, tranquilizers, and other drugs. One well documented

case of anaphylactic reaction to DEET has been reported. One fatal

case of encephalopathy in a child heterozygous for ornithine carbamoyl

transferase deficiency resembled Reyes syndrome, but the postmortem

appearance of the liver was not characteristic of the syndrome.

[ DP; Recognition and Management of Pesticide Poisonings. 4th

ed, p.50 EPA 540/9-88-001. Washington, DC: U.S. Government Printing

Office, March 1989]**PEER REVIEWED**

**********

Adult exposures -- military and civilian personnel (This heading is

added):

BULLOUS ERUPTIONS, SKIN NECROSIS, & PROLONGED DISABILITY WAS REPORTED

IN MILITARY PERSONNEL IN SOUTH VIETNAM. ALTHOUGH AN INSECT HAD BEEN

PREVIOUSLY THOUGHT WHOLLY THE CULPRIT, DIETHYL TOLUAMIDE, INSECT

REPELLENT USED PRODUCES SIMILAR ERUPTIONS. CAUTION ADVISED.

[LAMBERG SI, MULRENNAN JA; ARCH DERMATOL 100 (5): 582-6 (1969)]**PEER

REVIEWED**

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A 42 year old woman with no prior atopic history touched a companion

who had just sprayed himself with repellent containing 52% deet.

Generalized pruritus rapidly developed and progressed to generalized

angioedema. The woman became nauseated and unconscious en route to

hospital, where her blood pressure was found to be 70/40 mm Hg. She

responded to treatment with epinephrine, diphenhydramine, and in

corticosteroids. Periorbital edema developed after another exposure to

deet I week later. In a controlled setting, a small amount of deet in

isopropyl alcohol was applied to the patient's forearm. Pruritus

occurred in the treated area within 15 sec and or progressed to

localized urticaria despite immediate washing of the arm. The patient

was treated with epinephrine and diphenhydramine when she reported

pruritis of lips and the contralateral arm. She responded to therapy,

but the localized urticaria lasted for over 1 hr. Isopropyl alcohol

alone elicited non response.

[, W.J., Jr., E.R. Laws, Jr., (eds.). Handbook of Pesticide

Toxicology. Volume 3. Classes of Pesticides. New York, NY: Academic

Press, Inc., 1991. 1503]**PEER REVIEWED**

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A 30 year old man following self-medication with 75% deet for a

papular, truncal, erythematous rash that was later diagnosed as

pityriasis rosea. It was his recollection that he had used deet

successfully to treat a similar condition 4 years previously.

Beginning 2 weeks prior to admission to the hospital, he daily applied

deet on one side of his body and entered a homemade sauna for 60-90

min; he emerged from the sauna, treated the other side of his body,

and reentered the sauna for another 60-90 min. This procedure was

continued for 1 week. He was occasionally lethargic and incoherent

following the deet-sauna treatment. Four days prior to admission, he

developed marked personality changes that included delusions of

grandeur and verbal aggressivity. He became more irritable and

belligerent and was admitted to the hospital, where he required

seclusion because of his violent behavior. His condition worsened and

was diagnosed as acute manic psychosis.

[, W.J., Jr., E.R. Laws, Jr., (eds.). Handbook of Pesticide

Toxicology. Volume 3. Classes of Pesticides. New York, NY: Academic

Press, Inc., 1991. 1504]**PEER REVIEWED**

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Serious adverse effects have occurred when used under tropical

conditions, when it was applied to areas of skin that were occluded

during sleep (mainly the antecubital and popliteal fossae). Under

these conditions, the skin became red and tender, then exhibited

blistering and erosion, leaving painful weeping denuded areas that

were slow to heal. Permanent scarring resulted from most of these

severe reactions.

[ DP; Recognition and Management of Pesticide Poisonings. 4th

ed, p.50 EPA 540/9-88-001. Washington, DC: U.S. Government Printing

Office, March 1989]**PEER REVIEWED**

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Toxic encephalopathic reactions have apparently occurred in rare

instances following dermal application, mainly in children who were

intensively treated. The more frequently cause of systemic toxicity

has been ingestion, deliberate in adults, accidental in young

children.

[ DP; Recognition and Management of Pesticide Poisonings. 4th

ed, p.50 EPA 540/9-88-001. Washington, DC: U.S. Government Printing

Office, March 1989]**PEER REVIEWED**

********************************

Emergency Medical Treatment

Clinical Effects:

SUMMARY OF EXPOSURE

0.2.1.1 ACUTE EXPOSURE

o DEET - The most commonly used product in this class is

N,N-Diethyl-M-toluamide, commonly referred to as DEET.

Toxicity is

primarily neurologic (encephalopathy, seizures, movement

disorders, coma)

and may occur via oral or dermal exposure, most commonly

in children.

Fatalities from ingestion and chronic dermal application of

DEET

containing products are rare, but have been described.

o OTHER COMPOUNDS may include the following:

1. ETHYL HEXANEDIOL is only slightly absorbed across the skin.

However, it is moderately toxic on ingestion, causing CNS

depression, liver,

and kidney injury.

2. INDALONE may cause slight skin irritation, plus kidney and

liver damage

following protracted application to the skin of animals.

3. DIMETHYL PHTHALATE has a low order of systemic toxicity.

When the volatilized esters are inhaled, they are

moderately irritating to the

mucous membranes. Extreme oral doses cause CNS depression

in animals.

4. N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE is not irritating

to skin; extreme doses cause excitement, then

depression.

5. 2,3,4,5-BIS (2-BUTYLENE)TETRAHYDRO-2-FURALDEHYDE and

DI-N-PROPYL ISOCINCHOMERONATE have low systemic toxic

potential in mammals, and are not significantly

irritating.

6. N,N-DIETHYLPHENYLACETAMIDE (DEPA) - Hepatotoxic in

animals in large doses.

7. VEHICLES - Ethyl and isopropyl alcohols and freon used as

vehicles may

contribute significantly to toxicity of some formulations.

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