{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:08:27Z","timestamp":1789740507136,"version":"4.0.1"},"reference-count":13,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This report details a rare and severe case of intentional pyridaben poisoning, highlighting the diagnostic challenges posed by its presentation with coma and anisocoria, and the successful treatment strategy employing extracorporeal blood purification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A patient in early 50\u2005s was found unconscious and admitted to the emergency department. Neurological examination revealed coma and bilateral, fixed, dilated pupils, initially raising strong suspicion for a catastrophic cerebrovascular accident. However, normal neuroimaging and subsequent arterial blood gas analysis revealed profound metabolic acidosis (pH 7.21, lactate &gt;17\u2005mmol\/L) with compensatory hyperventilation. Further history from relatives suggested a suicidal attempt following familial discord, later confirmed by the discovery of a pyridaben container at her home. Toxicological monitoring is essential for confirming the diagnosis; however, this test could not be performed at our institution. We have therefore acknowledged this limitation in the Discussion section. The patient's condition deteriorated with refractory hypotension and generalized seizures. Management included endotracheal intubation, mechanical ventilation, vasopressor support, and seizure control. A combination of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) was initiated for enhanced toxin elimination and metabolic correction. The patient showed remarkable improvement; lactate levels normalized within 13\u2005h, and she regained full consciousness with intact neurological function 23\u2005h post-admission. She was successfully weaned from the ventilator on day 4 and was discharged after a full recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores that pyridaben poisoning can mimic brainstem herniation, but the finding of unexplained severe lactic acidosis is a pivotal diagnostic clue. A multifaceted management approach, including early extracorporeal blood purification with HP and CRRT, can be life-saving and lead to complete neurological recovery even in the most severe presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03000605261485126","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:56:52Z","timestamp":1789415812000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Another Etiology of persistent pupillary fluctuations: A case of pesticide poisoning"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4549-1279","authenticated-orcid":false,"given":"Haitao","family":"Yu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Zheng","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingliang","family":"Lu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Li","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Fang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/head.12246"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fchem.2022.975491"},{"key":"e_1_3_3_4_2","first-page":"75","article-title":"One case of successful treatment for acute poisoning of the pesticide Acetamiprid and pyridaben","volume":"43","author":"Zhang TJ","year":"2025","unstructured":"Zhang TJ, Zhang JY. One case of successful treatment for acute poisoning of the pesticide Acetamiprid and pyridaben. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2025 Jan 20; 43: 75\u201377. PMID: 39909603. Chinese.","journal-title":"Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000039160"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1144970"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2017.05.008"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000001603"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000057"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2024.04.004"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-024-07777-x"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.16379"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2487211"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2018.33.e208"}],"container-title":["Journal of International Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261485126","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03000605261485126","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261485126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:46:11Z","timestamp":1789739171000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03000605261485126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/03000605261485126"],"URL":"https:\/\/doi.org\/10.1177\/03000605261485126","relation":{},"ISSN":["0300-0605","1473-2300"],"issn-type":[{"value":"0300-0605","type":"print"},{"value":"1473-2300","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"03000605261485126"}}