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Contacto, Dela Cruz, Dumduma, Gabo, Gonzaga, Ignacio, Rivera,Sabili, Yang
Toxicants in Play
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Background of the Study
In 2004, the top five causes of death in low-income countries were pneumonia, followed byheart disease, diarrhea, HIV/AIDS and stroke
Due to the expected economic growth in low and
middle-income countries, globally by 2030, thefour leading causes of death are predicted to beischemic heart disease, cerebrovasculardiseases, COPD, and lower respiratory
infections. Environmental exposures contribute significantly
to these diseases
Identifying the various toxicants in the
environment is the first step in addressing theexpected prevalence of diseases in the years to
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Statement of the Problem
This study attempts to investigate thepossible toxicities arising from theexposure to the playground toxicants. Indoing so, the researchers will be able tovalidate the presence of thehypothesized toxicant in the area.
Specifically, it aims to answer thefollowing: Are the pre-identified toxicants present in
the playground?
Do the visitors and employees of theplayground show signs of toxicity from
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Hypotheses
Ha: The visitors and employees of the
Childrens Playground show signs oftoxicities from the playground toxicants.
Ho: The visitors and employees of the
Childrens Playground do not show signs
of toxicities from the playgroundtoxicants.
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Significance of the Study
The results of this study will be of greatimportance to the creation of preventivemeasures to protect the public from theharmful effects of toxicants found in the
area.Not only will the information generated from
this study be important in the treatment ofthe presently prevailing diseases but also
in the early diagnosis of the patients whohad been exposed to the toxicants in thearea.
Furthermore, this study may also arouse the
concern of the government to look moreclosely into the kind of environment that
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Scope and Delimitations
The results of this study will only beapplicable to the area where weconducted our research, the National
Park Development Committee:Childrens Playground in T.M. Kalaw St.,Ermita, Manila.
The questions that were asked in the
survey/ interview were based from thesigns and symptoms of the toxicantspre-identified by the toxicologystudents.
This stud will not deal will the
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Of the Toxicants
Theoretical Background
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Organophosphates- the pesticide/nerve gas
Mechanism of ToxicityOrganophosphate derivatives act by
combining with and inactivating the
enzyme acetylcholinesterase (AChE).This inactivation is irreversible resultingto accumulation of large amounts ofacetylcholine that will result to acholinergic crisis. It is to note thatorganophosphate combination with theenzyme will undergo aging within a fewminutes to some hours. This aging stageremoves one Phosphorus-oxygen bond
that makes the enzyme-OP bond
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Organophosphates
Cardinal Signs and SymptomsVisual disturbances
Respiratory difficulty
Urinary incontinence
AntidotesAtropine
Pralidoxime
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Carbamates- the carbamateinsecticide
Mechanism of ToxicityCarbamate poisoning will result to a
similar mechanism with that of
organophosphates. They combine andinactivate the acetylcholinesteraseenzyme which will lead to accumulationof acetylcholine leading to cholinergiccrisis. However this is reversible sincethe strength of the enzyme OC bond isweaker than the enzyme-OP bond andaging does not occur.
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Carbamates
Cardinal Signs and SymptomsSame symptoms as ORGANOPHOSPHATES
Extensive tearing
Excessive weaknessDizziness
AntidotesAtropine
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Pyrethrum- the Chrysanthemumorganic insecticide
Mechanism of ToxicityBinds to sodium channels, which cause
the delay in sodium channel closing, i.e.,prolonged sodium inactivation. These
substances exhibit a negative afterpotential, indicating that the axon doesnot readily recover to its resting stage.
These substances also cause repetitive
discharges of axonal action potentials inresponse to a single stimulus. Therefore,it can be readily excited again. Theexcessive neuroexcitation caused bythese substances results in
hyperactivity, tremors, and rigidaral sis.
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Pyrethrum
Cardinal Signs and Symptoms Hypersensitivity reactions may occur. In the
skin, the usual lesion is a mild erythematousdermatitis with vesicles, intense puritis and
a bullous dermatitis.
Antidotes
Hypersensitivity reactions should be treatedwith antihistamines, corticosteriods, andbronchodilators
Anaphylaxis may require adrenaline
Contact dermatitis can be treated usinglocal corticosteroids.
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Sodium Monofluoroacetate-pesticide, thecoyote killer
Mechanism of ToxicityFluoroacetate disrupts the citric acid cycle
(also known as the Krebs cycle) by
combining with coenzyme A to formfluoroacetyl CoA, which reacts withcitrate synthase to produce fluorocitrate.A metabolite of fluorocitrate binds verytightly to aconitase, thereby halting thecitric acid cycle. This inhibition results inan accumulation of citrate in the bloodwhich deprives cells of energy.
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Sodium Monofluoroacetate
Cardinal Signs and SymptomsExcitability
Hyperactivity
Convulsions
AntidotesMonoacetin
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Hypochlorite- the swimming pooldisinfectant
Mechanism of Toxicity Intoxications with chlorate salts are
characterized by methemoglobin
formation, hemolysis and renalinsufficiency. It causes a biosyntheticalteration in cellular metabolism and aphospholipid destruction, a formation ofchloramines which interferes in cellularmetabolism, an oxidative action withirreversible enzymatic inactivation inbacteria, and a lipid and fatty aciddegradation
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Hypochlorite
Cardinal Signs and SymptomsEye and throat irritation
AntidotesSodium thiosulfate
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Camphor- rust protectant, the mothrepellant
Mechanism of ToxicityCamphor specifically inhibits
catecholamine secretion by blocking ACh
without affecting agonist binding Camphor causes convulsions by stimulatingthe cells of the cerebral cortex.
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Camphor
Cardinal Signs and SymptomsVertigo
Hallucinations
Convulsions
AntidotesControl convulsions with diazepam
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Fluorides- insecticide the antkiller
Mechanism of ToxicityFluoride binds to calcium and magnesium,
causing hypocalcemia andhypomagnesemia.
Fluoride disrupts many intracellularmechanisms, including glycolysis, G-protein mediated signalling, oxidativephosphorylation, adenosine triphosphate(ATP) production, function of NA/K-ATPase, & potassium channels.
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Fluorides
Cardinal Signs and SymptomsMinor overexposure in children under age
10 can cause tooth mottling
High chronic overexposure can causefluorosis white specks or black/ brown stains on teeth
AntidotesHypercalcemia- IV Calcium Gluconate
Hypomagnesemia- IV Magnesium sulfate
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Sulfites- toxicant in bottled water
Mechanism of Toxicity Ingestion of food containing sulfating
agents can result in Type 1 immediatehypersensitivity reactions in normal,non- asthmatic individuals
Reactions have occurred without evidencefor IgE- mediated mechanisms inasthmatics
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Sulfites
Cardinal Signs and SymptomsBeefy red skin rash, most often affecting
palms, soles, buttocks, and scrotum
characteristic smell of rotten eggs in themouth
Treatment If renal failure occurs, hemodialysis may
be necessary to sustain fluid balanceand normal extracellular fluidcomposition
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Diquat- the aquatic herbicide
Mechanism of toxicityThe mechanism of poisoning has not been
fully elucidated, but it is believed toinvolve inhibition of superoxidedismutase in the lungs, making the lungsparticularly susceptible to oxygentoxicity.
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Diquat
Cardinal Signs and SymptomsRespiratory irritation
Lung injury
AntidotesGastrointestinal decontamination using
bentonite (7.5% suspension), Fullers
Earth (15% suspension), and activatedcharcoal
h i
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Strychnine-pesticide thebitter killer
Mechanism of ToxicityStrychnine is a competitive antagonist of
the inhibitory neurotransmitter glycine atreceptors in the spinal cord, brain stemand higher centers. It results inincreased neuronal activity andexcitability, leading to increasedmuscular activity.
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Strychnine
Cardinal Signs and SymptomsConvulsionsUncontrollable arching of neck and backjaw tightness
TreatmentTreatment consists of removing the drug from
the body (decontamination) and gettingsupportive medical care in a hospital setting
Supportive care includes intravenous fluids(fluids injected directly into a vein),medications for convulsions and spasms,and cooling measures for high temperature
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Organochlorines- the insecticideDDT
Mechanism of ToxicityToxicity in humans is largely due to
stimulation of the central nervoussystem. The organochlorines disturb the
neuronal membrane causinghyperexcitability of the nervous system.Specifically, cyclodienes,hexachlorocyclohexanes, and toxapheneorganochlorines inhibit GABA-mediatedchloride influx in the CNS, while DDTaffects potassium and voltage-dependent sodium channels. Thesechanges can result in agitation,
confusion, and seizures. Cardiac effectshave been attributed to sensitization of
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Organochlorines
Cardinal Signs and SymptomsHeadache, dizziness, nausea and vomitingKidney and Liver failure
TreatmentDermal decontaminationGI decontamination- Cholestyramine may
be used alternatively to bind thesehighly lipophilic agents. It reducesreabsorption and retains bound agent inthe GI tract for fecal elimination.
li id
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Oxalic Acid- the pulpwoodbleach
Mechanism of ToxicityOxalates combines with serum calcium to
form an insoluble calcium oxalate. Thiswill lead to a decrease in the bloodcalcium (Ca+2 )level leading to violentmuscular stimulation with convulsionsand collapse.
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Oxalic Acid
Cardinal Signs and symptomsAnuria
Cyanosis
Slow healing ulcers
Antidotesprecipitate oxalate by giving calcium orally
P t i B t h
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Potassium Bromate- thedye
Mechanism of ToxicityOn contact with acids, such as gastric
hydrochloric acid, potassium bromatereleases hydrogen bromate, which isan irritating acid.
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Potassium Bromate
Cardinal Signs and symptomsCyanosis
Vomiting and collapse
AntidotesSodium thiosulfate
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Sodium Perborate- in cleaningproducts & bleaches
Mechanism of toxicity It appears that boron has a special affinity
for the central nervous system, liver andbody fat
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Sodium Perborate
Cardinal signs and symptomsBoiled lobster appearance, erythematous
and exfoliative rash
Anemia
AntidotesSkin Decontamination- wash skin with
soap and waterGI Decontamination- Remove poison by
ipecac emesis followed by activatedcharcoal
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Methodology
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The Research Area
NationalParkDevelopmentCommittee: ChildrensPlaygroundat T.M.Kalaw St.,Ermita,Manila.
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Interview Questionnaire
The questions that were asked were basedon the signs and symptoms of thetoxicants pre-identified by the researchers.
The questions were designed in such a waythat will validate the exposure to thepossible toxicants.
Based on the number of positive responses
to each question, the researchers will beable to identify if the respondents wereindeed suffering from intoxication due toexposure to the toxicants.
Twenty nine respondents were interviewed,
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Interpretation and Analysis ofResults
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Pre- identified Toxicants
Question No. Type of Toxicant Signs and Symptoms
1 Organophosphates Urinary incontinence, confusion, anxiety
2 Carbamates Extensive tearing, excessive weakness, dizziness
3 Pyrethrum Severe dermatitis
4 Na monofluoroacetate Hyperactivity, convulsions
5 Hypochlorite Eye and throat irritation
6 Camphor Vertigo, hallucinations
7 Fluorides Fluorosis, white specks or black/ brown specks on teeth
8 Sulfites Beefy red skin rash, most often affecting palms, soles, buttocks, and scrotum;characteristic smell of rotten eggs in the mouth
9 Diquat Lung damage
10 Strychnine Uncontrollable arching of neck and back, jaw tightness
11 Organochlorines Liver and kidney failure
12 Oxalic Acid Slow healing ulcers
13 Potassium Bromate Cyanosis
14 Sodium Perborate Peeling of the skin particularly in the palm, soles or buttocks
15 Sodium Perborate Anemia
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Survey Results
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Interpretation
The data gathered from the survey show that majority ofthe respondents do not exhibit any signs or symptoms of
toxicity from the pre-identified toxicants. On the otherhand, a significant number of respondents responded
positive to the survey questions
59% of the respondents said that they experienceeye and throat irritation, a sign of hypochloritepoisoning
Poisoning with strychnine was also prevalent, signs
of which were uncontrollable arching of neck andback accompanied by tightness of the jaw, whichreceived 52% positive response
41% of the respondents said that they experienceextensive tearing, excessive weakness and
dizziness which are signs of carbamate toxicity and
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Interpretation
The responses from other toxicants were notas significant as that with hypochlorite,
strychnine, carbamates and sodium perborate
38% of the respondents showed signs ofpyrethrum toxicity
34% of the respondents showed signs of toxicitywith camphor
31% of the respondents showed signs of toxicity
with fluorides21% of the respondents showed signs of toxicity
with organophosphates, sodiummonofluoroacetate and sulphites
7% of the respondents showed signs of toxicity
with diquat, organochlorines and oxalic acid
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Respondents Predisposed to Other Types ofToxicants
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Interpretation
The respondents were also asked abouttheir vices in order to determinewhether they were also predisposed to
intoxication with other agents asidefrom the pre-identified poisons
The results of the survey show that
majority of the respondents wereneither alcoholics nor smokers
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Discussion of Results
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Discussion
As observed from the gathered data at theNational Park Development Committee:Childrens Playground at T.M. Kalaw St.,Ermita, Manila, the possible toxicants thatare present in the area are hypochlorites,strychnine, carbamates, and sodiumperborate. Due to the escalation ofpesticide use, the uncontrolled applicationof various cleaning agents, and theirinappropriate storage and disposal, visitorswho often go to the playground and staythere for a long period of time with theirfamilies or friends become exposed toacute toxicities of these agents. Employeeswho take care of the said area are moreexposed, since they are the ones utilizing
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In the study, considerable toxicity(greater than 40%) has been seen in theemployees of the park and on some ofthe perennial visitors. Eye and throat
irritation, excessive tearing andweakness, and peeling of the skin in thepalm, soles or buttocks are some of thesigns and symptoms experienced by the
workers and visitors interviewed. Thereare also other signs of toxicities found inthe area but they are not as prevalentas the four mentioned above.
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Proper use, handling and disposal of theseagents should be implemented strictly byadministrations of different recreationalparks for the health safety of the general
public visiting these places. Employeesshould be well-informed or properlyeducated on these chemicals, and howthese would affect the public health. Theyalso have to ensure easy access to firstaids on these chemicals (if applicable), incase acute poisoning from these chemicalsoccurs. Substitution to other cleaningalternatives that incur less or no toxicity