Lindane:An Organochlorine

Pesticide

Pesticide Health Effects Medical Education Database (PHEMED 2010)

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About Organochlorine Pesticides

Organochlorines …• Are chlorinated synthetic organic molecules which may contain

sulfur as well • Tend to be fat soluble• Are readily absorbed from the gastrointestinal tract and to a lesser

degree, through the skin• Have a wide range of acute & chronic health effects• Are categorized as Persistent Organic Pollutants (POPs)

meaning they persist in the environment and accumulate in tissues of living organisms

A little history …

• Most organochlorines have been banned in the United States because of their long half lives.

• The most notorious organochlorine, DDT, was banned in the US 1972.

• Others that have been banned since then include: aldrin, dieldrin, heptachlor, toxaphene and chlordane.

• Organochlorines still in use include lindane, dicofol, methoxychlor, and pentachorophenol; endosulfan will be in use until current supplies are exhausted.

Lindane is used to …

• Protect crop seeds from insects

• Control pests and ticks in forests, on pets and livestock

• Control ants and other household pests

• Control lice and scabies in humans

Lindane Regulations

In the US …• The Environmental Protection Agency (EPA)

banned Lindane for agricultural uses in 2006.• The Food and Drug Administration allowed Lindane in pharmaceutical products (such as shampoos and

lotions) by prescription

• EPA approved the cancellation of Lindane effective Oct 1 2009• Lindane is likely to be found in homes for a few years

Globally… • In May 2009, the Stockholm Convention on Persistent Organic Pollutants issued a provision that included

Lindane in a list of pollutants to be phased out.

Pesticide Health Effects Medical Education Database (PHEMED)

Symptoms of Lindane Toxicity

Toxicology of Organochlorines

• Exposure occurs through ingestion, inhalation and dermal absorption.

• Gastrointestinal and dermal absorption is enhanced by the presence of fats.

• Organochlorines tend to be stored in fat tissue, Lindane to a lesser extent than others.

• Excretion: o The chief route of excretion is biliaryo Nearly all organochlorines yield urinary metabolites

• The primary toxic action occurs on the central nervous system causing hyperexcitability

Array of Symptoms Associated with Lindane Poisoning

• Convulsions• Cough• Dizziness• Headache• Nausea and vomiting• Tremors• Ataxia• Muscular weakness• Paraesthesias of

face, tongue and extremities

May also cause eye, ear,nose, throat or dermalirritation and severerespiratory problems suchas respiratory depression

Typical Order of Symptom Occurrence:

Organochlorine Poisoning

• Symptoms begin to appear about 20 minutes to one hour after exposure

• The progression of symptoms depends on dose and susceptibility of affected person

Source: Carl Zenz, Occupational Medicine, 3rd. Ed.., St. Louis: Mosby 1994

• Nausea• Vomiting• Restlessness• Tremor• Apprehension• Convulsions• Coma • Respiratory

Failure• Death

A Few Facts About Lindane

Poisoning with Lindane …

• Most probable route is ingestion … though Lindane is efficiently absorbed through the skin, especially abraded skin.

• Should not be used by …o pregnant or nursing womeno infantso persons with excoriated skino persons with seizure disorders

Pesticide Health Effects Medical Education Database (PHEMED)

Diagnosing Lindane Poisoning

Diagnosing Lindane Poisoning

Blood, tissue and urine determinations oforganochlorine pesticides are available from alimited number of laboratories; however, this testingis rarely useful for Lindane because of its rapidMetabolism.

Diagnosing Lindane Poisoning: Health History

• The health and exposure history is the primary means to identify Lindane (and other pesticides) as the cause of symptoms.

• The history should determine:o The name of the pesticide product used

(for Lindane – lotion, cream or shampoo)o Route of exposure (oral, skin, inhaled, eye)o The amount of the substance ingested, inhaled or absorbedo Circumstance of exposure – intentional or accidentalo How did it happen?o What actions have been taken (e.g., home remedies)?

Lindane Poisoning:A Differential Diagnosis

The common symptoms ofLindane poisoning may beconfused with many otherconditions such as:• Brain infections• Meningitis• Viral infections• Food poisoning• And many more….

• Laboratory studies to rule out other causes of symptoms may include:o Electrolytes,o Renal panelo Liver function testso Arterial blood gaso Urinalysis

• Imaging studies may include:o Chest or abdominal radiographyo CT scan o Lumbar puncture

• Other testso Electroencephalogram

Chronic Problems Associated with Lindane and other Organochlorines

Studies that have explored possible correlations include:– Various types of cancer (Xu X et al., 2010; Chiu BC et al., 2009;

Purdue M, 2007)– Neurological damage (several organochlorines are known

neurotoxins) (Kamel F et al., 2005; Mladenovic D et al., 2010)– Parkinson's disease (Corrigan, FM, 2000; Hammond DB et al.

2008)– Respiratory illness (Valcin M. et al., 2007)– Birth defects (Fernandez, MF et al., 2007; Matsuura, I, 2005;

Pierik, FH et al., 2007)– Abnormal immune system function (Farr SL et al., 2004)

Other Facts about Lindane*

• Lindane has been a second line treatment for scabies and lice. Alternatives include pyrethrins & permethrins.

• Available products should be limited and will become more scarce as time goes on.

• Most serious adverse events are related to misuse of prescription Lindane.

*http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/UCM052201

Pesticide Health Effects Medical Education Database (PHEMED)

Treatment of Organocholorine

Poisoning

First Aid Measures

• Ingestion:o Rinse Moutho Do not induce vomiting (patient may aspirate)o Give plenty of water to drink

• Dermal exposure:o Remove any contaminated clothing;o Wash skin

• Refer for medical attention

Treatment for Lindane (and other organochlorine) Poisoning

• If the pesticide has been ingested …– Gastric lavage with 2 to 4 liters of tap water– follow with saline purgative (30 gram sodium sulfate in

250 mL water) • To control restlessness and/or convulsions …

– Barbiturate or diazepam IM or IV in appropriate dosage– Make sure patient is physically safe

• Mechanical respiratory assistance with oxygen if needed

Treatment (continued)

• If severely poisoned, monitor cardiac status and pulmonary ventilation

• DO NOT GIVE epinephrine or other adrenergic amines. The heart is also hyperexcitable.

• DO NOT GIVE vegetable oils or fats by mouth (enhanced GI absorption)

Follow-up Considerations

• After 6 hours of observation, determine if patient needs to be admitted or sent home.

• Survey for on-going home, school or work exposure

• Instruct patient and/or family regarding safe storage of pesticides

• Provide verbal and written information about pesticide poisoning

References

• Chiu, BC & Blair, A (2009). Pesticides, chromosomal aberrations, and non-Hodgkins lymphoma. Journal of Agromedicine, 14(2)250-255.

• Corrigan, FM et al. (2000). Organochlorine pesticides in substantia nigra in Parkinson’s disease. Journal of Toxicology and Environmental Health, 59(4):229-234

• Farr SL et al. (2004). Pesticide use and menstrual cycle characteristics among premenopausal women in the Agricultural Health Study. American Journal of Epidemiology, 160(12):1194-204.)

• Fernandez, MF et al. (2004). Human exposure to endocrine-disrupting chemicals and prenatal risk factors for cryptorchidism and hypospadias: a nested case-control study. Environmental Health Perspectives, 15 Suppl 1:8-14.

• Hammond DB et al. (2008). Pesticide exposure and risk of Parkinson's disease: a family-based case-control study. BMC Neurology 8:6 .

• Kamel F, et al. (2005). Neurologic Symptoms in Licensed Private Pesticide Applicators in the Agricultural Health Study. Environmental Health Perspectives 113:877–882.

• Matsuura, I et al., (2005). Evaluation of a two-generation reproduction toxicity study adding endpoints to detect endocrine-disrupting activity using lindane. Journal of Toxicology Science, 30 Spec No.:135-161.

References (continued)…• Mladenovic, D et al., (2010) The correlation between lipid

peroxidationin different brain regions and the severity of lindane-induced seizures in rats. Molecular Cellular Biochemistry, 333(1-2):243-50.

• Pierik FH et al Maternal pregnancy serum level of heptachlor epoxide, hexachlorobenzene, and beta-hexachlorocyclohexane and risk of cryptorchidism in offspring. (2007). Environmental Research, 105(3):364-9.

• Purdue M. (2007). Occupational exposure to organochlorine insecticides and cancer incidence in the Agricultural Health Study. International Journal of Cancer. 1;120(3):642-9.

• Valcin M, et al. (2007). Chronic bronchitis among nonsmoking farm women in the agricultural health study. Journal of Occupational Environmental Medicine, 49(5):574-83.]

• Xu, X,et al. (2010). Association of serum concentrations of organochlorine pesticides with breast cancer and prostate cancer in U.S. adults. Environmental Health Perspectives, 118(1):60-66