Pesticides

Insecticide: organophosphates, carbamates,

organochlorines, pyrethrins

Rodenticide: coumarin, thallium, zinc phosphine

Herbicide: paraquat, glyphosate

Organophosphate
Insecticide
Parathion
Malathion
Fenthion
Dimethoate
Monocrotophos
Metamidophos

Carbamate
Insecticide
Carbaryl
Carbofuran
Propanocarb
Thiodicarb

Route of exposure
Inhalation : unlikely at ordinary temperatures, low
volatility
: sprays or dusts
: hydrocarbon solvent (toluene or xylene)
Skin/eye contact

: not irritate skin or eye

: rapidly absorbed through intact skin
and eyes, contributing to systemic
toxicity

Ingestion: acute toxicity and rapidly fatal systemic

poisoning

Organophosphate
Chemical warfare

Nerve agents
Tabun
Sarin
Soman
VX

Sarin Gas Attack in Japan

June 1994,
Matsumoto (614)
March 1995,
Tokyo subway (5510)

Mechanism of Intoxication

Muscarinic Receptor
D
U
M
B
E
L
S

= Defecation
= Urination
= Miosis
= Bradycardia
= Emesis
= Lacrimation
= Secretion

Investigation

True Cholinesterase (RBC)

Cholinesterase level
Plasma Cholinesterase

Managem
ent
1. Basic life support
Airway
Breathing
Circulation

2. Early mangement
Prevent absorption:
gastric lavage
activated charcoal
skin decontamination
Enhance Elimination

Pralidoxime (2-PAM)
Dose: 1-2 gm IV push > 10 min every 2-4 hr.
or IV continuos drip
Max: 1/2 gm/ hr.
Clinical response: Motor power
- tidal volume
- muscle power

ATROPINE
2 mg IV EVERY 10 mins

ATROPINISATION

0.06 mg/kg/hr

Intermediate Syndrome
1- 4 days after acute poisoning
Sign: cranial nerve palsy
paralysis of proximal limb muscle, neck muscle
& respiratory
Fenthion, monocrotophos, dimethoate,
methamidophos etc.
DDx: redistribution of organophosphate
Treatment: supportive

Organophosphate induce
delayed neuropathy (OPIDN)

After 2- 4 wks after acute poisoning

Delay neuropathy: cramping muscle pain

distal numbness & paresthesia
progressive leg weakness and gait disturbance
depressed deep tendon reflexes
lower then upper extremeties

Organochlorine poisoning

Organochlorine

DDT

Benzene HC Cyclodienes
Lindane**

Toxaphene

Aldrin
Endrin
Chlordane
Chlordecon
e
***

***

**

**

Inhalation

Ingestion

Dermal

Clinical Manifestation

Acute toxicity
Seizure threshold &

Respiratory failure
1-2 hr. postingestion

CNS stimulant

tremor

paresthesia

Ca2+- ATPase
neuronal membrane
Increase Na+ Channel
opening time

myoclonus

ocular movement

weakness

Chronic toxicity
Chlordecone: factory workers who prolong

exposured
pseudotumor cerebri
oligospermia & decrease sperm motility
wt loss, tremor weakness, ataxia
metal status change,
abn liver function test

Carcinogen

Management
Basic life support
Early management

Prevent absorption: gastric lavage

activated Charcoal
skin decontamination

Support treatment: seizure

Paraquat
Herbicides

Diquat

2,4dichlorophenoxyacetic acid

Color : Blue-green
emetic agent

O2
Paraquat

GSH

GSSG

O2
Lung

Type I and II pneumocyte cell death & alveolitis

Lung fibrosis

OH
Lipid
peroxidation

TREATMENT
1. Basic life support
2. Prevent absorption
2.1 Gastric lavage
2.2 Fullers earth
2.3 MOM 30 ml q 6 hrs
2.4 Skin decontamination

O2

3. Increase elimination
3.1 Hemodialysis/ Hemoperfusion
4. Modification of tissue toxicities
4.1 Modulate inflammatory responses
- Cyclophosphamide 5mg/kg/day IV
divided to every 8 hr
- Dexamethazone 10 mg IV q 8 hr
- Chlorpheniramine 4 mg 1 tab po qid

4.2 Prevent oxidation

- Vit C (500mg/amp) 6 g/day IV
- Vit E (400 i.u./ tab) 2 tabs qid
- N-acetylcysteine (300mg/amp)
50mg/kg
every 8 hr

THANK YOU