index of signs and symptoms of acute poisoning244 index of signs and symptoms of acute poisoning...
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244
Index of Signs and Symptoms of Acute Poisoning
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 suspi-cion 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 mani-festations.
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.” Obvi-ously, 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 diag-nosis, and are therefore not included in these tables.
Common symptoms were not included:
• malaise
• fatigue
• dizziness
• nausea
• vomiting
245
SYST
EM: G
ener
al/N
on-S
peci
ficSYMPTOMS/
SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Rotten egg odor Sulfur
Hypothermia Creosote
Hyperthermia (fever, pyrexia)
NitrophenolsPentachlorophenol
BorateThallium
MetaldehydeInorganic arsenicals
Chlorophenoxy compounds
Cadmium dustsNaphthalene
Chills PhosphineArsine
Hot sensations NitrophenolsChlordimeform
Pentachlorophenol
Myalgia ParaquatChlorophenoxy
compounds
Thirst PentachlorophenolNitrophenols
Inorganic arsenicalsPhosphorusPhosphides
Sodium FluorideCholecalciferolAminopyridine
BorateEndothall
Anorexia OrganophosphatesN-methyl carbamates
NicotinePentachlorophenolHexachlorobenzene
ChlordimeformCholecalciferol
Halocarbon fumigantsNitrophenols
Inorganic arsenicalsAmino pyridine
Alcohol intolerance ThiramCalcium cyanamide
Sweet taste in the mouth Chlordimeform
Metallic taste in the mouth Inorganic arsenicalsOrganic mercury
Salty, soapy taste In the mouth
Sodium fluoride
INDEX Signs and Symptoms
General andNon-Specific
246
INDEX Signs and Symptoms
SYST
EM: S
kin
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Irritation, rash, blistering, or
erosion (without sensitization)
Copper, organotin, and cadmium compounds
Metam sodiumParaquat
DiquatSodium chlorate
PhosphorusSulfurThiram
ChlordimeformCationic detergentsHexachlorophene
Ethylene oxideFormaldehyde
AcroleinMethyl bromide
Ethylene dibromideDibromochlorpropane
DichloropropaneEndothall
Aliphatic acids
PentachlorophenolPicloram
ChlorophenoxyCaptan
RotenoneDiethyltoluamide (DEET)
CreosoteFungicides
Herbicides with irritant properties
Petroleum distillate
Contact dermatitis PCPParaquat
DEETChlorhexidine
CreosoteHexachlorophene
Pyrethrins/pyrethroidsChlorothalonil
ThiramThiophthalimides
PropachlorPropargite
Ethylene oxide
BarbanCaptafol
Formaldehyde
Flushing CyanamideNitrophenol
Thiram plus alcohol
Beefy red palms, soles Borate
Urticaria ChlorhexidinePCP
DEET
FluoridePentachlorophenol
Bullae Liquid fumigants Hexachlorobenzene
Pallor OrganochlorinesFumigants
Sodium fluorideCreosote
CoumarinsIndandiones
Skin
247
SYST
EM: S
kin,
con
t.SYMPTOMS/
SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Cyanosis Sodium chlorateParaquat
Cadmium dustsSodium fluoroacetate
StrychnineCrimidineNicotine
Organochlorines
OrganophosphatesN-methyl carbamates
Yellow stain Nitrophenols
Keratoses, brown discoloration
Inorganic arsenicals
Ecchymoses CoumarinsIndandiones
PhosphorusPhosphides
Jaundice Carbon tetrachlorideChloroformPhosphorusPhosphidesPhosphineParaquat
Sodium chlorate
Inorganic arsenicalsDiquat
Copper compounds
Excessive hair growth Hexachlorobenzene
Loss of hair Thallium Inorganic arsenicals
Loss of fingernails ParaquatInorganic arsenicals
Brittle nails, white striations Inorganic arsenicals Thallium
Sweating, diaphoresis OrganophosphatesN-methyl carbamates
NicotinePentachlorophenol
NaphthaleneAminopyridine
Copper compounds
INDEX Signs and Symptoms
Skin
248
INDEX Signs and Symptoms
SYST
EM: E
ye
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Conjunctivitis (irritation of mucous membranes, tearing)
ChloropicrinAcrolein
Copper compoundsOrganotin compoundsCadmium compounds
Metam sodiumParaquat
DiquatAcrolein
ChloropicrinSulfur dioxideNaphthalene
FormaldehydeEthylene oxideMethyl bromide
EndothallTolueneXyleneFipronil
ThiophthalimidesThiram
ThiocarbamatesPentachlorophenol
Chlorophenoxy compounds
ChlorothalonilPicloramCreosote
Aliphatic acidsStrobilurin fungicides
Pyrethrins
Lacrimation (muscarinic) OrganophosphatesN-methyl carbamates
Yellow sclerae Nitrophenols Agents that cause jaundice (see section on Skin)
Keratitis Paraquat
Ptosis Thallium
Diplopia OrganophosphatesN-methyl carbamates
Nicotine
Photophobia Organotin compounds
Constricted visual fields Organic mercury
Optic atrophy Thallium
Miosis OrganophosphatesN-methyl carbamates
Nicotine (early)
Dilated pupils CyanideFluoride
Nicotine (late)
Non-reactive pupils Cyanide
Eye
249
SYST
EM: N
ervo
us S
yste
mSYMPTOMS/
SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Paresthesia
PyrethroidsOrganochlorines
Inorganic arsenicalsOrganic mercuryCarbon disulfide
Pyriminil
OrganophosphatesThiabendazole Phosphides
Sodium fluoroacetateThallium
Headache OrganophosphatesN-methyl carbamates
NicotineInorganic arsenicals
Organic mercuryCadmium compoundsOrganotin compoundsCopper compounds
ThalliumFluorideBorates
NaphthalenePhosphine
Halocarbon fumigantsCreosote
DiquatCholecalciferol
CyanamideNeonicotinoids
Fipronil
OrganochlorinesNitrophenols
ThiramPentachlorophenol
ParaquatDEET
Behavioral – mood disturbances
(confusion, excitement, mania, disorientation,
emotional lability)
Organic mercuryInorganic arsenicals
Organotin compoundsThalliumNicotine
Sodium fluoroacetateDiquat
CyanideNitrophenols
AminopyridineCarbon disulfideMethyl bromide
Fipronil
OrganophosphatesN-methyl carbamates
PentachlorophenolSodium fluoride
DEETOrganochlorinesNeonicotinoids
INDEX Signs and Symptoms
Nervous System
250
INDEX Signs and Symptoms
SYST
EM: N
ervo
us S
yste
m, c
ont.
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Depression, stupor, coma OrganophosphatesN-methyl carbamates
(particularly in children)Sodium fluoride
BorateDiquatFipronil
Avermectins
Inorganic arsenicalsMetaldehyde
Sulfuryl fluorideHalocarbon fumigants
PhosphorusPhosphineParaquat
Chlorophenoxy compounds
DEETAlkyl phthalates
Seizures/convulsions (clonic-tonic) sometimes
leading to coma
OrganochlorinesStrychnineCrimidine
Sodium fluoroacetateNicotineCyanide
AcrylonitrileMetaldehyde
Thallium DEET
ChlorobenzilateCarbon disulfide
PhosphinePovidone-iodine
HexachloropheneSodium chlorate
CreosoteEndothallFluoride
NitrophenolsPentachlorophenolInorganic arsenicals
Organotin compoundsDiquatBorate
Sulfuryl fluorideMethyl bromideChlorophenoxy
compoundsOrganophosphates
N-methyl carbamates Aminopyridine
Fipronil
Muscle twitching/fasciculation
OrganophosphatesN-methyl carbamates
NicotineSulfuryl fluoride
Pyrethroids
Organic mercuryChlorophenoxy
compounds
Myotonia Chlorophenoxy compounds
Tetany, carpopedal spasms FluoridePhosphidesPhosphorus
Nervous System
251
SYST
EM: N
ervo
us S
yste
m, c
ont.
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Tremor Organic mercuryThallium
OrganophosphatesN-methyl carbamates
NicotineMetaldehyde
BoratesNeonicotinoids
Pyrethroids
PentachlorophenolNitrophenols
Thiram
Incoordination(including ataxia)
Halocarbon fumigantsOrganophosphates
N-methyl carbamates Carbon disulfide
NicotineThallium
Organic mercuryOrganochlorinesChlorobenzilate
ParalysisParesis, muscle weakness
Inorganic arsenicalsOrganophosphates
N-methyl carbamates Nicotine
Neonicotinoids
Organic mercuryDEET
Hearing loss Organic mercury
SYST
EM: C
ardi
ovas
cula
r
Hypotension and shock PhosphorusPhosphidesPhosphine
Sodium fluorideSodium chlorate
BorateThallium
Copper compoundsEndothall
Cyanamide
Inorganic arsenicalsNicotine (late)
CreosoteAlkyl phthalateCycloheximideFormaldehyde
Hypertension Thallium (early)Nicotine (early)
Organophosphates
Cardiac arrhythmias Sodium fluoroacetateHalocarbon fumigants
NicotineSodium fluorideEthylene oxide
Sodium chlorateThallium-ventricular
Povidone-iodineVeratrum alkaloid
(sabadilla)Neonicotinoids
Inorganic arsenicalsPhosphorusPhosphidesPhosphine
OrganochlorinesCyanide
AcrylonitrileFluoride
INDEX Signs and Symptoms
Nervous System
Cardiovascular System
252
INDEX Signs and Symptoms
SYST
EM: C
ardi
o, c
ont.
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Bradycardia (sometimes to asystole)
CyanideOrganophosphates
N-methyl carbamates
Nicotine (late)
Tachycardia NitrophenolsCyanamide
Nicotine (early)Neonicotinoids
MetaldehydeOrganophosphates (early,
before bradycardia)Pentachlorophenol
SYST
EM: R
espi
rato
rySYMPTOMS/
SIGNS/DISEASE CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Upper respiratory tract irritation, rhinitis, scratchy
throat, cough
NaphthaleneParaquat
ChloropicrinAcrolein
DichloropropeneEthylene dibromide
Sulfur dioxide Sulfuryl fluoride
AcrylonitrileFormaldehydeCadmium dusts
PyrethroidsStrobilurin fungicides
Dry formulation of copper, tin, zinc compounds
Dusts of thiocarbamate and other organic
pesticidesChlorophenoxy
compoundsAliphatic acids
Rotenone
Sneezing Sabadilla
Runny nose Pyrethrins/ pyrethroidsInorganic arsenicalsOrganophosphates
N-methyl carbamates
Dry formulation of copper, tin, zinc compounds
Dusts of thiocarbamate and other organic
pesticidesChlorophenoxy
compoundsAliphatic acids
Rotenone
Pulmonary edema(many chemicals come
packaged in a hydrocarbon vehicle, well known to
cause pulmonary edema)
Methyl bromidePhosphine
PhosphorusPhosphine
Ethylene oxideEthylene dibromide
AcroleinPyrethroids
Sulfur dioxideCationic detergents
CreosoteMethylisothiocyanate
Cadmium
OrganophosphatesN-methyl carbamates
ParaquatPhosphides
Cardiovascular System
Respiratory System
253
SYST
EM: R
espi
rato
ry, c
ont. Pulmonary consolidation Paraquat
Cadmium dustsMethyl bromide
Diquat
Dyspnea OrganophosphatesN-methyl carbamates
NicotineParaquat
Cadmium dustsCyanamide
Sulfuryl fluoridePentachlorophenol
Methyl bromideSulfur dioxideChloropicrin
Neonicotinoids
NitrophenolsCyanideCreosotePyrethrins
Pyrethroids
SYST
EM: G
astr
oint
estin
al T
ract
and
Liv
er
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Diarrhea (non-bloody) OrganophosphatesN-methyl carbamates
PyrethroidsBoratesSulfur
NicotineB. thuringiensis
ThiramCadmium
Avermectins
Cationic detergentsCresol
HexachloropheneChlorophenoxy
Diarrhea (bloody) FluorideParaquat
DiquatThallium
CoumarinsIndandiones
EndothallArsenicals
PhosphorusPhosphides
Cycloheximide
Stomatitis Inorganic arsenicalsParaquat
DiquatCopper compounds
Thallium
Salivation OrganophosphatesN-methyl carbamates
PyrethroidsNicotine
AminopyridineSodium fluoride
CyanideCadmium compounds
INDEX Signs and Symptoms
Respiratory System
Gastrointestinal Tract and Liver
254
Signs and Symptoms
SYST
EM: G
I Tra
ct a
nd L
iver
, con
t.
Abdominal pain OrganophosphatesN-methyl carbamates
ParaquatDiquat
NicotineMetaldehyde
FluorideBorate
PhosphorousPhosphides
Inorganic arsenicalsCadmium compoundsCopper compounds
Thallium Organotin compounds
Neonicotinoids
Chlorophenoxy compounds
Aliphatic acidsSodium chlorate
CreosoteEndothall
AminopyridineCoumarins
IndandionesFumigants (ingested)
Cycloheximide
Ileus ThalliumDiquat
Pyriminil
Constipation Pyriminil
SYST
EM: L
iver
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Enlargement Copper compoundsSodium chlorate
PhosphineCarbon tetrachloride
Chloroform
Inorganic arsenicalsHexachlorobenzene
Jaundice (see section on Skin)
SYST
EM: K
idne
y
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Proteinuria/hematuria and acute renal failure
Inorganic arsenicalsCopper compounds
Sodium fluorideNaphthalene
BorateNitrophenols
PentachlorophenolSodium chlorateSulfuryl fluoride
ParaquatDiquatArsine
Ethylene dibromide
Cadmium compoundsPhosphorusPhosphidesPhosphine
Chlorophenoxy compounds
CreosoteOrganotin compounds
Gastrointestinal Tract and Liver
Liver
Kidney
255
SYST
EM: K
idne
yRhabdomyolysis Neonicotinoids
Avermectins
Dysuria, hematuria, pyuria Chlordimeform
Polyuria Cholecalciferol Fluoride
Hemoglobinuria NaphthaleneSodium chlorate
Arsine
Wine-red urine (porphyrinuria)
Hexachlorobenzene
Smoky urine CreosoteEndothall
Glycosuria Organotin compounds
Ketonuria Borate
SYST
EM: B
lood
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Hemolysis NaphthaleneSodium chlorate
Arsine
Copper compoundsCresol
Methemoglobinemia Sodium chlorateCreosotePropanil
Metobromuron
ChlordimeformCyanideCresolCopper Arsine
DiflubenzuronNitrophenolMetolachlor
Hypoprothrombinemia CoumarinsIndandiones
PhosphorusPhosphides
Carbon tetrachloride
Hyperkalemia Sodium chlorateNaphthalene
Arsine
Sodium fluoride
Hypocalcemia Fluoride ThalliumPhosphorusPhosphides
Hypercalcemia Cholecalciferol
Carboxyhemoglobinemia Organotin compounds
Anemia NaphthaleneSodium chlorate
ArsineInorganic arsenicals
Leukopenia, Thrombocytopenia
Inorganic arsenicals
INDEX Signs and Symptoms
Kidney
Blood
256
INDEX Signs and Symptoms
SYST
EM: B
lood
, con
t.
Elevated LDHGOT, GPT,
alkaline phosphatase, ALT, AST enzymes
Carbon tetrachlorideChloroformPhosphine
Inorganic arsenicalsPhosphorusPhosphides
Sodium chlorateNitrophenols
PentachlorophenolThallium
OrganochlorinesChlorophenoxy
compounds
Depressed RBC acetylcholinesterase
and plasma pseudocholinesterase
Organophosphates N-methyl carbamates
SYST
EM: R
epro
duct
ive
SYMPTOMS/SIGNS/DISEASE
CATEGORIES
CHARACTERISTIC OF THESE POISONINGS
MAY OCCUR IN THESE POISONINGS
Low sperm count Dibromochloropropane Kepone
Blood
Reproductive System