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He was very aggressive, with tearing, salivation, hypothermia (32.6��C), hypotension (95/70 mmHg) and anuria, without respiratory failure. The clinical situation had become increasingly severe over the preceding 72 h, without any specific cause. The laboratory findings showed: glucose 7.44 mmol/L (134 mg/100 mL), urea 46.48 AP24534 clinical trial mmol/L (280 mg/100 mL), creatinine 1428.54 ?mol/L (16.16 mg/100 mL), sodium 141 mmol/L (141 mEq/L), potassium 7.6 mmol/L (7.6 mEq/L), chloride 113 mmol/L (113 mEq/L), albumin 42 g/L (4.2 g/100 mL), pH 6.86, HCO3 44 mmol/L, (44 mEq/L), pCO2 3.32 kPa (25 mmHg), lactate 1.2 mmol/L (10.8 mg/100 mL), ionic calcium 1.1 mmol/L (4.5 mg/100 mL), ethanol UNC2881 seg, prothrombin activity 7%, myoglobin 352.4 ?g/L, haemoglobin 99 g/L (9900 mg/100 mL), normocytic and normochromic, leucocytes 12.7 �� 109/L (12.7 �� 103/mm3) (neutrophils 86%) and platelets 205 �� 109/L (205 �� 103/mL). Serum amylase and the liver function test were normal. The patient was admitted to the nephrology unit, where a temporary catheter was inserted in the femoral vein and he underwent three sessions of high-flux dialysis with a PEPA? membrane, of 2 h each to 200 mL/min blood flux. He had to receive noradrenalin because of haemodynamic instability. He then showed a gradual recovery of diuresis and an improvement in general health, learn more with the disappearance of the other symptoms. He was discharged 12 days later with a plasma creatinine level of 257.24 ?mol/L (2.91 mg/100 mL; Figure 1). Shortly after, the patient's wife admitted to have been using Zoovec? (Diazinon)��the same agent her husband used at work��to disinfect the upholstery of a sofa (in a room used primarily by her husband for relaxation) several times during the previous month. This agent is used as a pesticide against fly larvae, lice, ticks and mites. It is an irreversible inhibitor of the enzyme acetylcholinesterase, which hydrolyses acetylcholine permitting its reuptake from the synaptic cleft. This inhibition provokes the accumulation of acetylcholine in the neural network. Thus, the insect's nervous system is continuously stimulated and this, ultimately, leads to death. Because of the suspicion of poisoning due to that agent, blood acetylcholinesterase levels were determined, proving to be 3714 kU/L (3714 U/mL; normal range: 4�C9 kU/L) at that time and 8432 kU/L (8432 U/mL) 5 months later. Fig. 1. Changes in creatinine levels during the patient's hospitalization. These results seem to confirm the diagnosis of delayed organophosphate poisoning as the cause of the patient's acute renal failure and the rest of the symptoms, since he was in contact with a small amount of the agent for a long time.