TABLE 2

Common Pesticides: Signs, Symptoms, and Management Considerationsa

ClassAcute Signs and SymptomsClinical Considerations
Organophosphate and N-methyl carbamate insecticides• Headache, nausea, vomiting, abdominal pain, and dizziness• Obtain red blood cell and plasma cholinesterase levels
• Hypersecretion: sweating, salivation, lacrimation, rhinorrhea, diarrhea, and bronchorrhea• Atropine is primary antidote
• Muscle fasciculation and weakness, and respiratory symptoms (bronchospasm, cough, wheezing, and respiratory depression)• Pralidoxime is also an antidote for organophosphate and acts as a cholinesterase reactivator
• Bradycardia, although early on, tachycardia may be present• Because carbamates generally produce a reversible cholinesterase inhibition, pralidoxime is not indicated in these poisonings
• Miosis
• Central nervous system: respiratory depression, lethargy, coma, and seizures
Pyrethroid insecticides• Similar findings found in organophosphates including the hypersecretion, muscle fasciculation, respiratory symptoms, and seizures• At times have been mistaken for acute organophosphate or carbamate poisoning
• Headache, fatigue, vomiting, diarrhea, and irritability• Symptomatic treatment
• Dermal: skin irritation and paresthesia• Treatment with high doses of atropine may yield significant adverse results
• Vitamin E oil for dermal symptoms
Neonicotinoid insecticides• Disorientation, severe agitation, drowsiness, dizziness, weakness, and in some situations, loss of consciousness• Supportive care
• Vomiting, sore throat, abdominal pain• Consider sedation for severe agitation
• Ulcerations in upper gastrointestinal tract• No available antidote
• No available diagnostic test
Fipronil (N-phenylpyrazole insecticides)• Nausea and vomiting• Supportive care
• Aphthous ulcers• No available antidote
• Altered mental status and coma• No available diagnostic test
• Seizures
Lindane (organochlorine insecticide)• Central nervous system: mental status changes and seizures• Control acute seizures with lorazepam
• Paresthesia, tremor, ataxia and hyperreflexia• Lindane blood level available as send out
Glyphosate (phosphonate herbicides)• Nausea and vomiting• Supportive care
• Aspiration pneumonia type syndrome• Pulmonary effects may be secondary to organic solvent
• Hypotension, altered mental status, and oliguria in severe cases
• Pulmonary effects may in fact be secondary to organic solvent
Chlorophenoxy herbicides• Skin and mucous membrane irritation• Consider urine alkalinization with sodium bicarbonate in IV fluids
• Vomiting, diarrhea, headache, confusion
• Metabolic acidosis is the hallmark
• Renal failure, hyperkalemia, and hypocalcemia
• Probable carcinogen
Rodenticides (long-acting anticoagulants)• Bleeding: gums, nose, and other mucous membrane sites• Consider PT (international normalized ratio)
• Bruising• Observation may be appropriate for some clinical scenarios in which it is not clear a child even ingested the agent
• Vitamin K indicated for active bleeding (IV vitamin K) or for elevated PT (oral vitamin K)
  • IV, intravenous; PT, prothrombin time.

  • a Expanded version of this table is available in the accompanying technical report.1