Imidacloprid belongs to a relatively new class of insecticides, chloronicotinyl neonicotinoid compounds that are agonists of insect postsynaptic nicotinic acetylcholine receptors (nAChrs). Imidacloprid insecticides have been believed to be of low toxicity to humans causing only mild symptoms such as vomiting, abdominal pain and headache in the majority of cases due to nicotinic receptor resistance. Despite the original belief that imidacloprid has low mammalian toxicity, evidence is increasing evidence that imidacloprid may cause heart, kidney and other organ damages and even death, besides gastrointestinal irritation and neurological symptoms. We report a case of acute ingestion of an imidacloprid-containing insecticide. Clinical manifestrations included hypotension and respiratory failure. A literature review is included.