Idea Transcript
Index of Signs and Symptoms of Acute Poisoning
Common symptoms were not included: • malaise • fatigue • dizziness • nausea • vomiting
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This index provides a table of pesticides and their related symptoms and signs and affected organ systems in poisoned individuals. This may be useful in raising the index of suspicion for pesticide toxicity where these signs and symptoms occur. Such suspicion can be evaluated further within the differential diagnosis as appropriate. It is important to keep in mind that the signs and symptoms listed have multiple causes, pesticidal and nonpesticidal. In addition, no specific symptoms or signs are invariably present in poisonings by particular pesticides. Toxicological presentation may vary based on dosage, route(s) of exposure, life stage of the patient, and patient’s genetic vulnerability, co-exposures and/or underlying health status. This complexity may explain why many poisonings are characterized by unexpected or atypical manifestations.
It is important to keep in mind that the signs and symptoms listed have multiple causes, pesticidal and nonpesticidal. The table does not differentiate clinical presentation by route of exposure or dosage. For example, effects of high-dose ingestion are not distinguished from effects of relatively low-dose dermal absorption, nor are topical effects distinguished from systemic dermal manifestations. Such details are addressed more fully in the chapters addressing the specific pesticides, which make up the bulk of this manual. The list of pesticides in this chapter is intended to serve as a clue for the clinician toward further inquiry. The word “poisoning” is used loosely in these headings to include topical as well as systemic effects that are acute manifestations rather than delayed sequelae or chronic conditions, although in some cases acute effects may persist. For chronic health conditions including long-term sequelae after acute poisoning and chronic conditions associated with lower level, repeat exposures, see Chapter 21, Chronic Effects. Pesticides that are relatively consistent in causing particular manifestations are listed in the column headed “Characteristic of These Poisonings.” Agents that are associated with conditions less consistently or are less prominent features of poisoning are listed in the right-hand column, headed “May Occur in These Poisonings.” Obviously, the distinction is not always clear cut. Some symptoms (malaise, fatigue, dizziness, nausea and vomiting) occur so commonly in poisoned individuals that they have little or no value in differential diagnosis, and are therefore not included in these tables.
INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
Rotten egg odor
Sulfur
Hypothermia
Creosote
Hyperthermia (fever, pyrexia)
Nitrophenols
Borate
Pentachlorophenol
Thallium
MAY OCCUR IN THESE POISONINGS
Metaldehyde Inorganic arsenicals Chlorophenoxy compounds Cadmium dusts Naphthalene Chills
Phosphine Arsine
SYSTEM: General/Non-Specific
Hot sensations
Nitrophenols
Pentachlorophenol
Chlordimeform Myalgia
General and Non-Specific
Paraquat Chlorophenoxy compounds
Thirst
Pentachlorophenol
Borate
Nitrophenols
Endothall
Inorganic arsenicals Phosphorus Phosphides Sodium Fluoride Cholecalciferol Aminopyridine Anorexia
Organophosphates
Halocarbon fumigants
N-methyl carbamates
Nitrophenols
Nicotine
Inorganic arsenicals
Pentachlorophenol
Amino pyridine
Hexachlorobenzene Chlordimeform Cholecalciferol Alcohol intolerance
Thiram Calcium cyanamide
Sweet taste in the mouth
Chlordimeform
Metallic taste in the mouth
Inorganic arsenicals Organic mercury
Salty, soapy taste
Sodium fluoride
In the mouth
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INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES Irritation, rash, blistering, or erosion (without sensitization)
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Copper, organotin, and cadmium compounds
Pentachlorophenol
Metam sodium
Chlorophenoxy
Paraquat Diquat Sodium chlorate Phosphorus Sulfur Thiram
Picloram Captan Rotenone Diethyltoluamide (DEET) Creosote Fungicides
Chlordimeform
Herbicides with irritant properties
Cationic detergents
Petroleum distillate
Hexachlorophene Ethylene oxide Formaldehyde Acrolein Methyl bromide
Skin
Ethylene dibromide Dibromochlorpropane
SYSTEM: Skin
Dichloropropane Endothall Aliphatic acids Contact dermatitis
PCP
Barban
Paraquat
Captafol
DEET
Formaldehyde
Chlorhexidine Creosote Hexachlorophene Pyrethrins/pyrethroids Chlorothalonil Thiram Thiophthalimides Propachlor Propargite Ethylene oxide Flushing
Cyanamide
Thiram plus alcohol
Nitrophenol Beefy red palms, soles
Borate
Urticaria
Chlorhexidine
Fluoride
PCP
Pentachlorophenol
DEET Bullae
Liquid fumigants
Hexachlorobenzene
Pallor
Organochlorines
Coumarins
Fumigants
Indandiones
Sodium fluoride Creosote
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INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
Cyanosis
Sodium chlorate
Organophosphates
Paraquat
N-methyl carbamates
MAY OCCUR IN THESE POISONINGS
Cadmium dusts Sodium fluoroacetate Strychnine Crimidine Nicotine Organochlorines Yellow stain
Nitrophenols
Keratoses, brown discoloration
Inorganic arsenicals
SYSTEM: Skin, cont.
Ecchymoses
Jaundice
Coumarins
Phosphorus
Indandiones
Phosphides
Carbon tetrachloride
Inorganic arsenicals
Chloroform
Diquat
Phosphorus
Copper compounds
Skin
Phosphides Phosphine Paraquat Sodium chlorate Excessive hair growth Loss of hair
Hexachlorobenzene Thallium
Loss of fingernails
Inorganic arsenicals
Paraquat Inorganic arsenicals
Brittle nails, white striations
Sweating, diaphoresis
Inorganic arsenicals
Thallium
Organophosphates
Copper compounds
N-methyl carbamates Nicotine Pentachlorophenol Naphthalene Aminopyridine
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INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS Thiophthalimides
Conjunctivitis
Chloropicrin
(irritation of mucous
Acrolein
Thiram
membranes, tearing)
Copper compounds
Thiocarbamates
Organotin compounds
Pentachlorophenol
Cadmium compounds
Chlorophenoxy compounds
Metam sodium Paraquat Diquat Acrolein Chloropicrin Sulfur dioxide Naphthalene
Chlorothalonil Picloram Creosote Aliphatic acids Strobilurin fungicides Pyrethrins
Formaldehyde Ethylene oxide Methyl bromide Endothall
Eye
Toluene
SYSTEM: Eye
Xylene Fipronil
Lacrimation (muscarinic)
Organophosphates N-methyl carbamates
Yellow sclerae
Nitrophenols
Keratitis
Paraquat
Ptosis
Thallium
Diplopia
Agents that cause jaundice (see section on Skin)
Organophosphates N-methyl carbamates Nicotine
Photophobia Constricted visual fields
Organotin compounds Organic mercury
Optic atrophy Miosis
Thallium Organophosphates
Nicotine (early)
N-methyl carbamates Dilated pupils
Cyanide Fluoride
Non-reactive pupils
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Cyanide
Nicotine (late)
INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES Paresthesia
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Pyrethroids
Organophosphates
Organochlorines
Thiabendazole Phosphides
Inorganic arsenicals
Sodium fluoroacetate
Organic mercury
Thallium
Carbon disulfide Pyriminil
Headache
Organophosphates
Organochlorines
N-methyl carbamates
Nitrophenols
Nicotine
Thiram
Inorganic arsenicals
Pentachlorophenol
Organic mercury
Paraquat
Cadmium compounds
DEET
Organotin compounds
Nervous System
SYSTEM: Nervous System
Copper compounds Thallium Fluoride Borates Naphthalene Phosphine Halocarbon fumigants Creosote Diquat Cholecalciferol Cyanamide Neonicotinoids Fipronil
Behavioral – mood disturbances (confusion, excitement, mania, disorientation, emotional lability)
Organic mercury
Organophosphates
Inorganic arsenicals
N-methyl carbamates Pentachlorophenol
Organotin compounds Thallium Nicotine Sodium fluoroacetate Diquat
Sodium fluoride DEET Organochlorines Neonicotinoids
Cyanide Nitrophenols Aminopyridine Carbon disulfide Methyl bromide Fipronil
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INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES Depression, stupor, coma
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Organophosphates
Inorganic arsenicals
N-methyl carbamates (particularly in children)
Sulfuryl fluoride
Sodium fluoride Borate Diquat Fipronil Avermectins
Metaldehyde Halocarbon fumigants Phosphorus Phosphine Paraquat Chlorophenoxy compounds DEET
Nervous System
SYSTEM: Nervous System, cont.
Alkyl phthalates
Seizures/convulsions (clonic-tonic) sometimes leading to coma
Organochlorines
Nitrophenols
Strychnine
Pentachlorophenol
Crimidine
Inorganic arsenicals
Sodium fluoroacetate
Organotin compounds
Nicotine
Diquat
Cyanide
Borate
Acrylonitrile
Sulfuryl fluoride
Metaldehyde
Methyl bromide
Thallium
Chlorophenoxy compounds
DEET Chlorobenzilate Carbon disulfide Phosphine Povidone-iodine
Organophosphates N-methyl carbamates Aminopyridine Fipronil
Hexachlorophene Sodium chlorate Creosote Endothall Fluoride
Muscle twitching/ fasciculation
Organophosphates
Organic mercury
N-methyl carbamates
Chlorophenoxy compounds
Nicotine Sulfuryl fluoride Pyrethroids Myotonia
Tetany, carpopedal spasms
Chlorophenoxy compounds Fluoride Phosphides Phosphorus
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SYSTEM: Nervous System, cont.
INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Tremor
Organic mercury
Pentachlorophenol
Thallium
Nitrophenols
Organophosphates
Thiram
N-methyl carbamates Nicotine Metaldehyde Borates Neonicotinoids Pyrethroids Incoordination (including ataxia)
Halocarbon fumigants
Organic mercury
Organophosphates
Organochlorines
N-methyl carbamates
Chlorobenzilate
Nervous System
Carbon disulfide Nicotine Thallium Paralysis
Inorganic arsenicals
Organic mercury
Paresis, muscle weakness
Organophosphates
DEET
N-methyl carbamates Nicotine
SYSTEM: Cardiovascular
Neonicotinoids Hearing loss
Organic mercury
Hypotension and shock
Phosphorus
Inorganic arsenicals
Phosphides
Nicotine (late)
Phosphine
Creosote
Sodium fluoride
Alkyl phthalate
Sodium chlorate
Cycloheximide
Borate
Formaldehyde
Thallium Copper compounds Endothall Cyanamide Hypertension
Thallium (early)
Organophosphates
Cardiac arrhythmias
Sodium fluoroacetate
Inorganic arsenicals
Halocarbon fumigants
Phosphorus
Nicotine
Phosphides
Sodium fluoride
Phosphine
Ethylene oxide
Organochlorines
Nicotine (early)
Sodium chlorate
Cyanide
Thallium-ventricular
Acrylonitrile
Povidone-iodine
Fluoride
Cardiovascular System
Veratrum alkaloid (sabadilla) Neonicotinoids
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Cardiovascular System
SYSTEM: Cardio, cont.
INDEX Signs and Symptoms SYMPTOMS/ SIGNS/DISEASE CATEGORIES Bradycardia (sometimes to asystole)
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Cyanide
Nicotine (late)
Organophosphates N-methyl carbamates
Tachycardia
Nitrophenols
Metaldehyde
Cyanamide
Organophosphates (early, before bradycardia)
Nicotine (early)
SYMPTOMS/ SIGNS/DISEASE CATEGORIES Upper respiratory tract irritation, rhinitis, scratchy throat, cough
Neonicotinoids
Pentachlorophenol
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Naphthalene
Dry formulation of copper, tin, zinc compounds
Paraquat Chloropicrin Acrolein Dichloropropene
Dusts of thiocarbamate and other organic pesticides
Ethylene dibromide
Chlorophenoxy compounds
Sulfur dioxide
Aliphatic acids
Sulfuryl fluoride
Rotenone
Acrylonitrile
Respiratory System
SYSTEM: Respiratory
Formaldehyde Cadmium dusts Pyrethroids Strobilurin fungicides Sneezing
Sabadilla
Runny nose
Pyrethrins/ pyrethroids Inorganic arsenicals Organophosphates N-methyl carbamates
Dusts of thiocarbamate and other organic pesticides Chlorophenoxy compounds Aliphatic acids Rotenone
Pulmonary edema
Methyl bromide
Organophosphates
(many chemicals come packaged in a hydrocarbon vehicle, well known to cause pulmonary edema)
Phosphine
N-methyl carbamates
Phosphorus
Paraquat
Phosphine
Phosphides
Ethylene oxide Ethylene dibromide Acrolein Pyrethroids Sulfur dioxide Cationic detergents Creosote Methylisothiocyanate Cadmium
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Dry formulation of copper, tin, zinc compounds
SYSTEM: Respiratory, cont.
INDEX Signs and Symptoms Pulmonary consolidation
Diquat
Methyl bromide Dyspnea
Organophosphates
Nitrophenols
N-methyl carbamates
Cyanide
Nicotine
Creosote
Paraquat
Pyrethrins
Cadmium dusts
Pyrethroids
Respiratory System
Cyanamide Sulfuryl fluoride Pentachlorophenol Methyl bromide Sulfur dioxide Chloropicrin Neonicotinoids
SYMPTOMS/ SIGNS/DISEASE CATEGORIES Diarrhea (non-bloody)
SYSTEM: Gastrointestinal Tract and Liver
Paraquat Cadmium dusts
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Organophosphates
Cationic detergents
N-methyl carbamates
Cresol
Pyrethroids
Hexachlorophene
Borates
Chlorophenoxy
Sulfur Nicotine B. thuringiensis Thiram
Gastrointestinal Tract and Liver
Cadmium Avermectins Diarrhea (bloody)
Fluoride
Phosphorus
Paraquat
Phosphides
Diquat
Cycloheximide
Thallium Coumarins Indandiones Endothall Arsenicals Stomatitis
Inorganic arsenicals
Thallium
Paraquat Diquat Copper compounds Salivation
Organophosphates N-methyl carbamates Pyrethroids Nicotine Aminopyridine Sodium fluoride Cyanide Cadmium compounds
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Signs and Symptoms
Liver
SYSTEM: Liver
Gastrointestinal Tract and Liver
SYSTEM: GI Tract and Liver, cont.
Abdominal pain
Paraquat Diquat Nicotine Metaldehyde Fluoride Borate Phosphorous Phosphides Inorganic arsenicals
SYSTEM: Kidney
Aliphatic acids Sodium chlorate Creosote Endothall Aminopyridine Coumarins Indandiones Fumigants (ingested) Cycloheximide
Copper compounds Thallium Organotin compounds Neonicotinoids Ileus
Thallium
Pyriminil
Diquat Constipation
Pyriminil
SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
Enlargement
Copper compounds
Inorganic arsenicals
Sodium chlorate
Hexachlorobenzene
MAY OCCUR IN THESE POISONINGS
Phosphine Carbon tetrachloride Chloroform Jaundice (see section on Skin)
Proteinuria/hematuria and acute renal failure
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Inorganic arsenicals
Cadmium compounds
Copper compounds
Phosphorus
Sodium fluoride
Phosphides
Naphthalene
Phosphine
Borate
Chlorophenoxy compounds
Nitrophenols Pentachlorophenol Sodium chlorate Sulfuryl fluoride Paraquat Diquat Arsine Ethylene dibromide
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Chlorophenoxy compounds
Cadmium compounds
SYMPTOMS/ SIGNS/DISEASE CATEGORIES
Kidney
Organophosphates N-methyl carbamates
Creosote Organotin compounds
INDEX Signs and Symptoms Rhabdomyolysis
Neonicotinoids
Dysuria, hematuria, pyuria
Chlordimeform
Polyuria
Cholecalciferol
SYSTEM: Kidney
Avermectins
Hemoglobinuria
Fluoride
Naphthalene Sodium chlorate Arsine
Wine-red urine (porphyrinuria) Smoky urine
Hexachlorobenzene
Kidney
Creosote Endothall
Glycosuria
Organotin compounds
Ketonuria
Borate
SYMPTOMS/ SIGNS/DISEASE CATEGORIES Hemolysis
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Naphthalene
Copper compounds
Sodium chlorate
Cresol
Arsine Methemoglobinemia
Sodium chlorate
Chlordimeform
Creosote
Cyanide
Propanil
Cresol
Metobromuron
Copper
Blood
Arsine
SYSTEM: Blood
Diflubenzuron Nitrophenol Metolachlor Hypoprothrombinemia
Coumarins Indandiones
Phosphorus Phosphides Carbon tetrachloride
Hyperkalemia
Sodium chlorate
Sodium fluoride
Naphthalene Arsine Hypocalcemia
Fluoride
Thallium Phosphorus Phosphides
Hypercalcemia
Cholecalciferol
Carboxyhemoglobinemia Anemia
Organotin compounds Naphthalene Sodium chlorate Arsine Inorganic arsenicals
Leukopenia,
Inorganic arsenicals
Thrombocytopenia
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Reproductive System
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SYSTEM: Reproductive
Blood
SYSTEM: Blood, cont.
INDEX Signs and Symptoms Elevated LDH
Carbon tetrachloride
Inorganic arsenicals
GOT, GPT,
Chloroform
Phosphorus
alkaline phosphatase,
Phosphine
ALT, AST enzymes
Phosphides Sodium chlorate Nitrophenols Pentachlorophenol Thallium Organochlorines Chlorophenoxy compounds
Depressed RBC
Organophosphates
N-methyl carbamates
SYMPTOMS/ SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Low sperm count
Dibromochloropropane
Kepone
acetylcholinesterase and plasma pseudocholinesterase