Insecticide Poisoning for OccMed1

8/16/2019 Insecticide Poisoning for OccMed1

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Diagnosis & Management Diagnosis & Managementofof

Insecticide Poisoning Insecticide Poisoning

Winai Wananukul, M.D. Ramathibodi Poison Center & Department of Medicine

Ramathibodi Hospital


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Winai Wananukul,Ramathibodi Poison

pidemiolog! of "o#ic #posure pidemiolog! of "o#ic #posure$Ma! % ' (pril % )*$Ma! % ' (pril % )*

+ccupational Products,.-

+thers/.&

Medical Products

%%.0

Pesticide0).,

Household Products

%).1


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Classification of Pesticide #posureClassification of Pesticide #posure

Insecticides50%

Herbicides22%

Rodenticides17%

Miticide6%

Synergist1%

Mollusticide1% Fungicide

1%Miscellaneous

1%

Plant growtregulator

1%


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Classification of Insecticide #posureClassification of Insecticide #posure

!arba"ate2#$#%

rgano& os& ate20$1%

Pyret roid17$'%

!o"bined1'$1%

(n)nown6$*%

Re&ellant2$0%

Fu"igant1$1% t ers

2$0%rganoc lorine

7$5%


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Classification of Herbicide #posureClassification of Herbicide #posure

+lycine52$,%

Para-uat20$5%

! loro& eno.y6$0%

! loroacetanilide6$0%

(n)nown2$6%

t ers12$6%


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Classification of Rodenticide #posureClassification of Rodenticide #posure

/inc P os&ide

#1$0%

Su&erwar arin,$#%

(n)nown6$'%

ar arin#'$7%


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Ratio of #posure 2ith and 2ithout clinical manifestation of Ratio of #posure 2ith and 2ithout clinical manifestation of poisoning at the time consult to the Poison Center poisoning at the time consult to the Poison Center

Without Clinical Manifestation of

Poisoning 46.7%

Clinical Poisoning

53.3%


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Medical +utcome of the Risk 3roup Medical +utcome of the Risk 3roup

No S/S 46.7%

Clinical Poisoning

53.3%

o 3 ects,#$,%

Minor 3 ects,2$2%

(nable to F('$7%

Moderate3 ect6$1%

Ma4or 3 ect'$0%

Death) ./


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Medical +utcome of the Poisoned 3roup Medical +utcome of the Poisoned 3roup

Clinical Poisoning

53.3%

No S/S 46.7%

Minor 3 ects#'$6%

Moderate3 ect10$'%

Ma4or 3 ect

1#$#%

Death)4.0

(nable to F(6$7%


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Medical +utcome of 5elected "o#ic #posure Medical +utcome of 5elected "o#ic #posure

0

50

100

150

200

250

Pesticides Medical

Products

House old

Products

ccu&ational

Products

eat Ma4or Moderate Minor o 3 ect


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0%

20%

#0%

60%

'0%

100%

PQ OC OP CB ZnP Gly PyrSur i e eat

5ur6i6al & Death Rate of 5elected Pesticide #posure5ur6i6al & Death Rate of 5elected Pesticide #posure$from high to lo2 mortalit! rate$from high to lo2 mortalit! rate * *

61$,%61$,% #2$,%#2$,%22$*%22$*% 20$0%20$0%

#$2%#$2% 2$5%2$5% 1$6%1$6%


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+rganophosphate+rganophosphate

and and Carbamate Poisoning Carbamate Poisoning


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What is (cute +rganophosphate & CarbamateWhat is (cute +rganophosphate & Carbamate Poisoning 7 Poisoning 7

5tate of (cet!lcholine #cess It is a combination of

Muscarinic receptor 8icotinic receptor C85 $unspecified*


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+rganophosphate 95. Carbamate Poisoning +rganophosphate 95. Carbamate Poisoning

Re6ersible 6s. Irre6ersible Inhibition

Re6ersible 6s. Irre6ersible clinical poisoning

"ime of clinical course

:lood brain barrier penetration

C85 s!mptoms $after e#clude h!po#ic effects*


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Clinical course after acute poisoning Clinical course after acute poisoning

Cholinergic #cess+thers $than cholinergic e#cess* Intermediate s!ndrome

Dela!ed neuropath! (rrth!mias


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Diagnosis of +rganophosphate or Carbamate Diagnosis of +rganophosphate or Carbamate Poisoning; Poisoning;

Clinical Diagnosis


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Management of +P & C: Poisoning Management of +P & C: Poisoning

5upporti6e Care 9ital signs Respiration;

8 secretion block and air2a! obstruction8 respirator! motor 2eakness

5ei=ure

5pecific "reatment


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Winai Wananukul, Ramathibodi Poison Center

(ir2a!

5kin

Parenteral

3I $ C i r c u

l a t i o n

"issues &+rgans

Ion "rapping R(C.

Decontamination Decontamination Increase Increase limination limination

(ntidotes (ntidotes

Hemodial!sis, Hemoperfusion


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9 :I!9 :I!

(8"ID+" 5 (8"ID+" 5


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Muscarinic 3 ectsMuscarinic 3 ectsHeart rateHeart rateSweatingSweatingSecretionSecretion

Pu&ilsPu&ils

(tropine (tropine


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(Ch Inhibitions (Ch Inhibitions 8icotinic 8icotinic Muscarinic Muscarinic

% P(M % P(M


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8icotinic ffects 8icotinic ffects Motor Po2er Motor Po2er

>> $Muscarinic ffects*$Muscarinic ffects*

% P(M % P(M


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Intermediate 5!ndrome Intermediate 5!ndrome

De6elop onl! after some acute organophosphate poisoning Mechanism; unkno2n

not directl! relate to acet!lcholine e#cessClinical Manifestation; Pro#imal muscle 2eakness :ulbar pals!


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Intermediate 5!ndrome Intermediate 5!ndrome

5pontaneous reco6er in % '- 2eeks after de6elop"reatment 5upporti6e care, especiall! respirator! care

8ote; this condition must be differentiated from?(ged (cet!lcholinesterase@


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Chronic +rganophosphate Poisoning Chronic +rganophosphate Poisoning

Clinical Aeatures; Dela! pol!neuropath! 8europs!chiatric disorder

Diagnosis Clinical diagnosis, b! suspicious & e#clusion In6estigation 77 Plasmacholinesterase

"reatment 8ot established


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3131

1/2 “ Egodan”½

! " #$ . % ER : HR 1 !/min, "P 1#!/11!,

RR 22/min

&' ( generali$ed toni% and %loni%sei$ure ) (E& tubeintubation * (i' (uid ( + dia$e)am


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3131

* un%ons%iousPu)il mm, rea%t to light bilateral+ung * %lear

bdomen * so-t, normal bo el soundeurologi%al signs* no sti0 ne%k,

motor )o er grossl inta%t,absent o- "abinsk s sign.


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+rganochlorine Poisoning +rganochlorine Poisoning


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Classification of +rganochlorineClassification of +rganochlorine

Dichlorodiphen!lethanes Dichlorodiphen!lethanes DD" Metho#!chlor

He#achloroc!clohe#ane He#achloroc!clohe#ane


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(cute +rganochlorine Poisoning (cute +rganochlorine Poisoning

Prodomal s!mptoms; tremor, ata#ia, Buick in6oluntar! erk $m!oclonus* di==iness, confusion

Paresthesia of month, nausea, 6omiting


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"he t!pical presentation; 5tatus epilepticus

Aollo2ed b!;

Respirator! failure Cardiac arrh!thmias

Rhabdom!ol!sis & acute renal failure


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"reatment;

Control sei=ure as the same 2a! as ?5tatus epilepticus@

8 :en=odia=epines

8 Phenobarbital

8 Phen!toin

Pre6ent complications


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Diagnosis of +rganocholine Poisoning Diagnosis of +rganocholine Poisoning

Clinical Diagnosis Histor! of e#posure Clinical features of repeated sei=ure


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5ubacute +rganochlorine Poisoning 5ubacute +rganochlorine Poisoning

H!pere#citabilit! stage; "ach!cardia "remor H!perrefle#ia"reatment 5!mptomatic P#; (n#iol!tic nhance limination ; Cholest!ramine


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Chronic +rganochlorine Poisoning Chronic +rganochlorine Poisoning

+rganochlorine insecticides interfere 2ith endocrineand reproducti6e s!stems.

People 2ho 2orking 2ith the insecticides ha6e lo2

sperm count and motilit!, infertilit! and abortion. "he insecticides ha6e also been reported to be

carcinogenic to animals.


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P!rethroid Poisoning P!rethroid Poisoning


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Classification of P!rethrins & P!rethroidsClassification of P!rethrins & P!rethroids

P!rethrinsCinerin I Cinerin II ustmolin I usmolin II

P!rethrin I P!rethrin II P!rethrum e#tract

"!pe I P!rethroids (llethrin :ioallethrin Cismethrin Eadethrin

Permethrin Phenothrin Resmethrin "etramethrin

"!pe II P!rethroidsC!halothrin C!permethrin C!phenothrin Deltamethrin

Aenpropenthrin Aen6alerate Alu6alinate


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P!rethroids #posure P!rethroids #posure

Direct "o#ic H!persensiti6it! (llergic rhinitis

:ronchitis :ronchial asthma (naph!lactic shock


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P!rethroid Poisoning; Insect P!rethroid Poisoning; Insect

"he t!pe I s!ndrome $caused b! t!pe I p!rethroids*;8 fine tremor

8 refle# h!pere#citabilit!

8 s!mpathetic acti6ation

"he t!pe II s!ndrome $caused b! t!pe II p!rethroids*;8 sali6ation

8 coarse tremor

8 choreoathetosia

8 refle# h!pere#citabilit!8 s!mpathetic acti6ation, and sei=ure


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P!rethroid Poisoning; Human P!rethroid Poisoning; Human

Fsuall! mild Common;

nausea and 6omiting after ingestion of p!rethroids.5e6er Cases; dro2siness, sei=ure and coma

$ In patient e#posed to large amount of p!rethroids,especiall! the product used in agriculture in higherconcentration*

Death from p!rethroid poisoning is rare.


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Diagnosis of P!rethroid Poisoning Diagnosis of P!rethroid Poisoning

Clinical Diagnosis


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Management of P!rethroid Poisoning Management of P!rethroid Poisoning

H!persensiti6it!; (drenaline Corticosteroids :ronchodilators (ntihistamine

Direct "o#ic; 5upporti6e treatment

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Insecticide Poisoning for OccMed1

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