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TABLE 2

Common Pesticides: Signs, Symptoms, and Management Considerationsa

ClassAcute Signs and SymptomsClinical Considerations
Organophosphate and N-methyl carbamate insecticides • Headache, nausea, vomiting, abdominal pain, and dizziness • Obtain red blood cell and plasma cholinesterase levels 
 • Hypersecretion: sweating, salivation, lacrimation, rhinorrhea, diarrhea, and bronchorrhea • Atropine is primary antidote 
 • Muscle fasciculation and weakness, and respiratory symptoms (bronchospasm, cough, wheezing, and respiratory depression) • Pralidoxime is also an antidote for organophosphate and acts as a cholinesterase reactivator 
 • Bradycardia, although early on, tachycardia may be present • Because carbamates generally produce a reversible cholinesterase inhibition, pralidoxime is not indicated in these poisonings 
 • Miosis  
 • Central nervous system: respiratory depression, lethargy, coma, and seizures  
Pyrethroid insecticides • Similar findings found in organophosphates including the hypersecretion, muscle fasciculation, respiratory symptoms, and seizures • At times have been mistaken for acute organophosphate or carbamate poisoning 
• Headache, fatigue, vomiting, diarrhea, and irritability • Symptomatic treatment 
• Dermal: skin irritation and paresthesia • Treatment with high doses of atropine may yield significant adverse results 
  • Vitamin E oil for dermal symptoms 
Neonicotinoid insecticides • Disorientation, severe agitation, drowsiness, dizziness, weakness, and in some situations, loss of consciousness • Supportive care 
 • Vomiting, sore throat, abdominal pain • Consider sedation for severe agitation 
 • Ulcerations in upper gastrointestinal tract • No available antidote 
  • No available diagnostic test 
Fipronil (N-phenylpyrazole insecticides) • Nausea and vomiting • Supportive care 
 • Aphthous ulcers • No available antidote 
 • Altered mental status and coma • No available diagnostic test 
 • Seizures  
Lindane (organochlorine insecticide) • Central nervous system: mental status changes and seizures • Control acute seizures with lorazepam 
 • Paresthesia, tremor, ataxia and hyperreflexia • Lindane blood level available as send out 
Glyphosate (phosphonate herbicides) • Nausea and vomiting • Supportive care 
 • Aspiration pneumonia type syndrome • Pulmonary effects may be secondary to organic solvent 
 • Hypotension, altered mental status, and oliguria in severe cases  
 • Pulmonary effects may in fact be secondary to organic solvent  
Chlorophenoxy herbicides • Skin and mucous membrane irritation • Consider urine alkalinization with sodium bicarbonate in IV fluids 
 • Vomiting, diarrhea, headache, confusion 
 • Metabolic acidosis is the hallmark 
 • Renal failure, hyperkalemia, and hypocalcemia 
 • Probable carcinogen 
Rodenticides (long-acting anticoagulants) • Bleeding: gums, nose, and other mucous membrane sites • Consider PT (international normalized ratio) 
 • Bruising • Observation may be appropriate for some clinical scenarios in which it is not clear a child even ingested the agent 
  • Vitamin K indicated for active bleeding (IV vitamin K) or for elevated PT (oral vitamin K) 
ClassAcute Signs and SymptomsClinical Considerations
Organophosphate and N-methyl carbamate insecticides • Headache, nausea, vomiting, abdominal pain, and dizziness • Obtain red blood cell and plasma cholinesterase levels 
 • Hypersecretion: sweating, salivation, lacrimation, rhinorrhea, diarrhea, and bronchorrhea • Atropine is primary antidote 
 • Muscle fasciculation and weakness, and respiratory symptoms (bronchospasm, cough, wheezing, and respiratory depression) • Pralidoxime is also an antidote for organophosphate and acts as a cholinesterase reactivator 
 • Bradycardia, although early on, tachycardia may be present • Because carbamates generally produce a reversible cholinesterase inhibition, pralidoxime is not indicated in these poisonings 
 • Miosis  
 • Central nervous system: respiratory depression, lethargy, coma, and seizures  
Pyrethroid insecticides • Similar findings found in organophosphates including the hypersecretion, muscle fasciculation, respiratory symptoms, and seizures • At times have been mistaken for acute organophosphate or carbamate poisoning 
• Headache, fatigue, vomiting, diarrhea, and irritability • Symptomatic treatment 
• Dermal: skin irritation and paresthesia • Treatment with high doses of atropine may yield significant adverse results 
  • Vitamin E oil for dermal symptoms 
Neonicotinoid insecticides • Disorientation, severe agitation, drowsiness, dizziness, weakness, and in some situations, loss of consciousness • Supportive care 
 • Vomiting, sore throat, abdominal pain • Consider sedation for severe agitation 
 • Ulcerations in upper gastrointestinal tract • No available antidote 
  • No available diagnostic test 
Fipronil (N-phenylpyrazole insecticides) • Nausea and vomiting • Supportive care 
 • Aphthous ulcers • No available antidote 
 • Altered mental status and coma • No available diagnostic test 
 • Seizures  
Lindane (organochlorine insecticide) • Central nervous system: mental status changes and seizures • Control acute seizures with lorazepam 
 • Paresthesia, tremor, ataxia and hyperreflexia • Lindane blood level available as send out 
Glyphosate (phosphonate herbicides) • Nausea and vomiting • Supportive care 
 • Aspiration pneumonia type syndrome • Pulmonary effects may be secondary to organic solvent 
 • Hypotension, altered mental status, and oliguria in severe cases  
 • Pulmonary effects may in fact be secondary to organic solvent  
Chlorophenoxy herbicides • Skin and mucous membrane irritation • Consider urine alkalinization with sodium bicarbonate in IV fluids 
 • Vomiting, diarrhea, headache, confusion 
 • Metabolic acidosis is the hallmark 
 • Renal failure, hyperkalemia, and hypocalcemia 
 • Probable carcinogen 
Rodenticides (long-acting anticoagulants) • Bleeding: gums, nose, and other mucous membrane sites • Consider PT (international normalized ratio) 
 • Bruising • Observation may be appropriate for some clinical scenarios in which it is not clear a child even ingested the agent 
  • Vitamin K indicated for active bleeding (IV vitamin K) or for elevated PT (oral vitamin K) 

IV, intravenous; PT, prothrombin time.

a

Expanded version of this table is available in the accompanying technical report.1 

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