Common Pesticides: Signs, Symptoms, and Management Considerationsa
| Class . | Acute Signs and Symptoms . | Clinical 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) |
| Class . | Acute Signs and Symptoms . | Clinical 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.
Expanded version of this table is available in the accompanying technical report.1