What are the most common symptoms of acute pesticide poisoning?
Acute pesticide poisoning can present with a wide range of symptoms depending on the chemical class involved (organophosphates, carbamates, pyrethroids, etc.). In your experience or research, what are the most common early signs and symptoms clinicians should watch for? How do these symptoms vary across different age groups, exp
2 days ago
The clinical manifestations of acute pesticide intoxication depend on the chemical class of the pesticide. The chemistry of the pesticide is important when considering probable clinical syndromes, where the four common syndromes are:
1. Organophosphates & Carbamates (Cholinergic Toxicity)
Mechanism: Inhibition of AChE → ↑ ACh(acetylcholinesterase) Common clinical presentation (SLUDGE/BBB): • Salivation • Lacrimation • Urination • Diarrhea • Gastrointestinal cramps • Vomiting • Bronchorrhea • Bronchospasm • Bradycardia • Fasciculations, miosis, altered mental status, seizures 2. Pyrethroids Mechanism: Sodium channel modulation Common clinical presentation: • Paresthesias (especially facial) • Tremors • Headache • Nausea • Seizures (high-dose) • Allergic symptoms (in previously sensitized patients) 3. Paraquat (Herbicide) Mechanism: Reactive oxygen species Common clinical presentation: • Immediate oral irritation, vomiting • Multi-organ failure • Delayed-onset pulmonary fibrosis 4. Chlorinated Hydrocarbons (e.g., DDT) Mechanism: Neuronal excitability - sodium channels Common clinical presentation: • Tremors • Seizures • Dizziness • Hepatotoxicity (less common)
Pediatric presentation vs Adult presentation • Children present more often with seizures and altered mental status. • Adults present more autonomic symptoms (i.e., bradycardia, SLUDGE symptoms).
Implication Early identification of the pesticide class is critical for targeted management. Atropine and pralidoxime for organophosphate/carbamate pesticide toxicity, and supportive care for everyone else. Consider dermal, inhalational, and GI exposure routes.