Index of Signs and Symptoms of Acute Poisoning - US EPA · PDF fileIndex of Signs and Symptoms of Acute Poisoning ... Cardiac arrhythmias Sodium fluoroacetate Halocarbon fumigants

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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


SYST

EM: S

kin

SYMPTOMS/SIGNS/DISEASE

CATEGORIES



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/




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


Skin

248


SYST

EM: E

ye


CATEGORIES



Conjunctivitis (irritation of mucous membranes, tearing)

ChloropicrinAcrolein

Copper compoundsOrganotin compoundsCadmium compounds

Metam sodiumParaquat

DiquatAcrolein

ChloropicrinSulfur dioxideNaphthalene

FormaldehydeEthylene oxideMethyl bromide

EndothallTolueneXyleneFipronil

ThiophthalimidesThiram

ThiocarbamatesPentachlorophenol


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/




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


PentachlorophenolSodium fluoride

DEETOrganochlorinesNeonicotinoids


Nervous System

250


SYST

EM: N

ervo

us S

yste

m, c

ont.


CATEGORIES



Depression, stupor, coma OrganophosphatesN-methyl carbamates

(particularly in children)Sodium fluoride

BorateDiquatFipronil

Avermectins

Inorganic arsenicalsMetaldehyde

Sulfuryl fluorideHalocarbon fumigants

PhosphorusPhosphineParaquat


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


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.


CATEGORIES



Tremor Organic mercuryThallium


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


Nervous System

Cardiovascular System

252


SYST

EM: C

ardi

o, c

ont.


CATEGORIES



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/




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


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


CATEGORIES



Diarrhea (non-bloody) OrganophosphatesN-methyl carbamates

PyrethroidsBoratesSulfur

NicotineB. thuringiensis

ThiramCadmium

Avermectins

Cationic detergentsCresol

HexachloropheneChlorophenoxy

Diarrhea (bloody) FluorideParaquat

DiquatThallium

CoumarinsIndandiones

EndothallArsenicals


Cycloheximide

Stomatitis Inorganic arsenicalsParaquat

DiquatCopper compounds

Thallium

Salivation OrganophosphatesN-methyl carbamates

PyrethroidsNicotine

AminopyridineSodium fluoride

CyanideCadmium compounds


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


Aliphatic acidsSodium chlorate

CreosoteEndothall

AminopyridineCoumarins

IndandionesFumigants (ingested)

Cycloheximide

Ileus ThalliumDiquat

Pyriminil

Constipation Pyriminil

SYST

EM: L

iver


CATEGORIES



Enlargement Copper compoundsSodium chlorate

PhosphineCarbon tetrachloride

Chloroform

Inorganic arsenicalsHexachlorobenzene

Jaundice (see section on Skin)

SYST

EM: K

idne

y


CATEGORIES



Proteinuria/hematuria and acute renal failure

Inorganic arsenicalsCopper compounds

Sodium fluorideNaphthalene

BorateNitrophenols

PentachlorophenolSodium chlorateSulfuryl fluoride

ParaquatDiquatArsine

Ethylene dibromide

Cadmium compoundsPhosphorusPhosphidesPhosphine


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


CATEGORIES



Hemolysis NaphthaleneSodium chlorate

Arsine

Copper compoundsCresol

Methemoglobinemia Sodium chlorateCreosotePropanil

Metobromuron

ChlordimeformCyanideCresolCopper Arsine

DiflubenzuronNitrophenolMetolachlor

Hypoprothrombinemia CoumarinsIndandiones


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


Kidney

Blood

256


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


CATEGORIES



Low sperm count Dibromochloropropane Kepone

Blood

Reproductive System

Documents

Index of Signs and Symptoms of Acute Poisoning - US EPA · PDF fileIndex of Signs and Symptoms of Acute Poisoning ... Cardiac arrhythmias Sodium fluoroacetate Halocarbon fumigants