Toxic encephalopathy associated with use of DEET insect repellents: a caseanalysis of its toxicity in children

(1) Respiratory distress and seizures developed in an 18-month-old boy foll owing brief exposure to low-strength (17.6%) N,N-diethyl-m-toluamide (DEET) . A review of the literature revealed 17 reports of DEET-induced encephalop athy in children. The objective of this study was to test the hypothesis th at the potential toxicity of DEET is high and that available repellents con taining DEET, irrespective of their strength, are not safe when applied to children's skin. (2) Although this is a case report, we used the features o f published reports of DEET- induced encephalopathy in children to support the diagnosis, since the evidence that the child's illness was caused by DE ET was circumstantial. In the following case analysis, clinical reports of children < 16 years old have been reviewed and analyzed in an effort to rel ate direct DEET toxicity to various clinical, demographic, and toxic compou nd exposure factors (Fisher's exact test and logistic regression analysis). (3) DEET-induced encephalopathy in children (56% girls) followed not only ingestion or repeated and extensive application of repellents, but also a b rief exposure to DEET (45%), Of those who reported a dermal exposure, 33% r eported an exposure to a product containing DEFT <20%. Seizures, the most p rominent symptom (72%), were significantly more frequent when DEET solution s were applied to the skin (P < 0.01). Mortality (16.6%) did not correlate significantly with the concentration of the DEET liquid used, duration of s kin exposure, pattern of use, age, or sex. (4) Data of this case analysis s uggest that repellents containing DEET are not safe when applied to childre n's skin and should be avoided in children. Additionally, since the potenti al toxicity of DEET is high, less toxic preparations should be probably sub stituted for DEFT-containing repellents, whenever possible.