Bulletin of the World Health Organization

Acute pesticide poisoning: a proposed classification tool

Josef G Thundiyil, Judy Stober, Nida Besbelli, Jenny Pronczuk

Volume 86, Number 3, March 2008, 205-209

Table 1. Adverse health effects caused by selected classes of pesticidesa

Chemical/chemical class Examples of pesticides Clinical presentation Route of exposureb
Arsenicals Arsenic trioxide, CCA, sodium arsenate Abdominal pain, nausea, vomiting, garlic odour, metallic taste, bloody diarrhoea, headache, dizziness, drowsiness, weakness, lethargy, delirium, shock, kidney insufficiency, neuropathy O, R, D (rarely)
Borates (insecticide) Boric acid, borax Upper airway irritation, abdominal pain, nausea, vomiting, diarrhoea, headache, lethargy, tremor, kidney insufficiency O, R, D (broken skin)
Carbamates (insecticide) Carbaryl, thiram, aldicarb, mecarbam Malaise, weakness, dizziness, sweating, headache, salivation, nausea, vomiting, diarrhoea, abdominal pain, confusion, dyspnea, dermatitis, pulmonary oedema O, D
Chlorphenoxy compounds(herbicides) Di/tri- chlorophenoxyacetic acid, MCPP Upper airway and mucous membrane irritation, abdominal pain vomiting, diarrhoea, tachycardia, weakness, muscle spasm, coma, acidosis, hypotension, ataxia, hypertonia, seizures, dermal irritation, headache, confusion, acidosis, tachycardia O, D
Calciferol (rodenticide) Cholecalciferol, ergocalciferol Fatigue, anorexia, weakness, headache, nausea, polyuria, polydipsia, renal injury, hypercalcemia O
Chloralose Chloralose Vomiting, vertigo, tremor, myoclonus, fasciculations, confusion, convulsions O
Copper compounds (fungicide) Copper acetate, copper oleate Abdominal pain, vomiting, skin/airway/mucous membrane irritation, renal dysfunction, coma O, R, D
Coumarins (rodenticide) Brodifacoum, warfarin, pindone Echymoses, epistaxis, excessive bleeding, haematuria, prolonged prothrombin time, intracranial bleed, anaemia, fatigue, dyspnea O, D (possible)
Diethyltoluamide (insect repellent) DEET (N,N-diethyl-meta-toluamide) Dermatitis, ocular irritation, headache, restlessness, ataxia, confusion, seizures, urticaria O, D
Dipyridil (herbicide) Paraquat, diquat Mucous membrane and airway irritation, abdominal pain, diarrhoea, vomiting, gastrointestinal bleeding, pulmonary oedema, dermatitis, renal and hepatic damage, coma, seizures O, D (via broken skin)
Phosphonates (herbicide) Roundup, glyphosate Airway, skin, and mucous membrane irritation, abdominal, pain, nausea, vomiting, shock, dyspnea, respiratory failure O, R
Fluoroacetate (rodenticide) Sodium fluoroacetate Vomiting, paresthesias, tremors, seizures, hallucinations, coma, confusion, arrhythmias, hypertension, cardiac failure O, D (possible)
Mercury, organic (fungicide) Methyl mercury Metallic taste, paresthesias, tremor, headache, weakness, delirium, ataxia, visual changes, dermatitis, renal dysfunction O, R, D
Metal phosphides(rodenticide, fumigant) Zinc-, aluminium-, magnesium- phosphide Abdominal pain, diarrhoea, acidosis, shock, jaundice, paresthesias, ataxia, tremors, coma, pulmonary oedema, tetany, dermal irritation O, R, D
Halocarbons (fumigant) Cellfume, Methyl bromide Skin/airway/mucous membrane irritant, cough, renal dysfunction, confusion, seizures, coma, pulmonary oedema O, R, D
Nitrophenolic and nitrocresolic herbicides Dinitrophenol, dinitrocresol, dinoseb, dinosarn Sweating, fever, confusion, malaise, restlessness, tachycardia, yellow skin staining, seizures, coma, renal insufficiency, hepatic damage O, R, D
Organochlorines (insecticide) Aldrin, dieldrin HCB, endrin, lindane Cyanosis, excitability, dizziness, headache, restlessness, tremors, convulsions, coma, paresthesias, nausea, vomiting, confusion, tremor, cardiac arrhythmias, acidosis O, R, D
Organophosphates (insecticides) Malathion, parathion, dichlorvos, chlorpyrifos Headache, dizziness, bradycardia, weakness, anxiety, excessive sweating, fasciculations, vomiting, diarrhoea, abdominal cramps, dyspnea, miosis, paralysis, salivation, tearing, ataxia, pulmonary oedema, confusion, acetylcholinesterase inhibition O, D
Organotin (fungicide) Fentin acetate, fentin chloride Airway, skin, and mucous membrane irritation, dermatitis, salivation, delirium, headache, vomiting, dizziness O, R, D
Phenol derivatives (Fungicide, wood preservative) Pentachlorophenol, dinitrophenol Skin, airway, and mucous membrane irritation, contact dermatitis, dyspnea, diaphoreses, urticaria, tachycardia, headache, abdominal pain, fever, tremor O, R, D
Pyrethrins, Pyrethroids Allethrin, cyfluthrin, permethrin Allergic reactions, anaphylaxis, dermatitis, paresthesias, wheezing, seizures, coma, pulmonary oedema, diarrhoea, abdominal pain R, D
Strychnine (rodenticide) Strychnine Muscle rigidity, opisthotonus, rhabdomyolysis O
Thallium (rodenticide) Thallium sulfate Abdominal pain, nausea, vomiting, bloody diarrhoea, headache, weakness, liver injury, hair loss, paresthesias, neuropathy, encephalopathy, cardiac failure O
Triazines (herbicide) Atrazine, prometryn Mucous membrane, ocular and dermal irritation O, R, D

CCA, chromated copper arsenate; HCB, hexachlorobenzene; MCPP, methyl chlorphenoxy propionic acid.a This list is an overview and is not meant to be a comprehensive list of all pesticide and pesticide classes. The health worker is encouraged to use other resources and clinical experience in establishing health effect and causality for acute pesticide poisoning. Suggested online references include: http://www.who.int/whopes/recommendations/IPCSPesticide_ok.pdf, http://npic.orst.edu/npicfact.htm, http://www.epa.gov/pesticides/safety/healthcare/handbook/handbook.pdf, http://www.cdc.gov/niosh/topics/pesticides/pdfs/pest-cd2app2v2.pdf, http://hazard.com/msds/, http://www.epa.gov/pesticides/reregistration/status.htm, http://pesticideinfo.org/, http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?HSDB, http://www.pesticideinfo.org/Search_Countries.jsp.b Route of exposure key: O, oral/ingestion; R, respiratory/inhalation; D, dermal or ocular.Based on references 22–24.

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