This insecticide has an active metabolite that uncouples oxidative phosphorylation and causes toxicity and death days after ingestion?
Chlorfenapyr is an insecticide that has an active metabolite, CL 303268. The metabolite uncouples oxidative phosphorylation. A recent case report describes a patient that intentionally ingested chlorfenapyr and developed diaphoresis, tachypnea, rigidity and hyperthermia on hospital day 6. His temperature peaked at 108 F and consistent with previous reports in the literature, he died on hospital day 6. (Chomin J et al. Delayed hyperthermia from chlorfenapyr overdose. American Journal of Emergency Medicine 2018; 36: 2129.e1-2129.e2)