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Malathion Poisoning

Poisoning with the organophosphate malathion can cause serious complications and possibly even death. This toxic substance is a common insecticide and an ingredient in certain treatment products for head lice.


Presentation

The timing and onset of symptoms in individuals with organophosphate poisoning depend on the dose, duration, and route of exposure of the specific toxic substance [1]. Children typically present with seizure and coma while adults are more likely to manifest with muscarinic or nicotinic effects [2]. The acute clinical picture traditionally features salivation, lacrimation, urination, defecation, gastric cramps, and emesis (SLUDGE).

Among the wide spectrum of CNS symptoms, patients may experience seizures, various types of paralysis, cranial nerve palsies, and muscle weakness [3] as well as muscle twitching and cramping. Neuropsychiatric symptoms include fatigue, anxiety, irritability, confusion, lethargy, cognitive impairment, loss of consciousness, and possibly coma [3].

Patients are very likely to develop respiratory manifestations such as wheezing, increased bronchial secretions, bronchospasm, bronchial narrowing, and respiratory depression [4]. They are also at risk for cardiovascular effects such as bradycardia, tachycardia, hypertension, hypotension, and arrhythmia [5].

Possible long-term outcomes include confusion, memory loss, and post-traumatic stress disorder [6] [7].

The leading causes of death are respiratory paralysis and cardiac arrest [8] [9].

Physical exam

The vital signs will be notable for abnormal heart rate and/or rhythm as well as blood pressure extremes. Additionally, mental status changes will be apparent. Patients may exhibit pinpoint pupils, slurred speech, gait ataxia, and a broad range of neurologic, respiratory, and behavioral symptoms.

Intravenous Administration
  • The traditional treatment has included oxygen, ventilatory support, and intravenous administration of atropine.[ncbi.nlm.nih.gov]
Cough
  • Tell your doctor about the allergy and what signs you had, like rash; hives ; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.[drugs.com]
Diarrhea
  • Low or high blood pressure Slow or rapid heart rate Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea[medlineplus.gov]
  • Indications: Organophosphate Poisoning (i.e. parathion, malathion, rid-a-bug) and carbamate (Baygon, sevin, and many common roach and ant sprays) Poisoning Signs “SLUDGE” Salivation Lacrimation Urination Defecation GI hypermotility (Emesis, diarrhea)[orangecountyfl.net]
  • She was found fallen in her room and complain of severe abdominal pain, salivation , lacrimation and diarrhea a few hours after the ingestion of the insecticide .[omicsonline.org]
  • Malathion Poisoning According to Oregon State University’s National Pesticide Information Center, people who are exposed to a high enough level of malathion can experience nausea, vomiting, muscle tremors, cramps, weakness, abdominal pain, and diarrhea[decodedscience.org]
  • Side effects of Ivermectin may include dizziness, loss of appetite, nausea, vomiting, stomach pain, diarrhea, constipation, weakness, sleepiness, uncontrollable shaking and chest discomfort. Lindane: Has been banned in over 53 countries.[theliceplace.com]
Vomiting
  • […] rapid heart rate Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea Loss of appetite Nausea and vomiting[medlineplus.gov]
  • Malathion Poisoning According to Oregon State University’s National Pesticide Information Center, people who are exposed to a high enough level of malathion can experience nausea, vomiting, muscle tremors, cramps, weakness, abdominal pain, and diarrhea[decodedscience.org]
  • All sixty developed nausea, vomiting and abdominal pain over the next three hours. They were taken to a local primary healthcare center where they received treatment for their symptoms (intravenous fluids, antiemetics and antibiotics).[panna.org]
  • Side effects of Ivermectin may include dizziness, loss of appetite, nausea, vomiting, stomach pain, diarrhea, constipation, weakness, sleepiness, uncontrollable shaking and chest discomfort. Lindane: Has been banned in over 53 countries.[theliceplace.com]
  • She was brought to a clinic after developing vomiting and diarrhea. She was also minimally responsive and struggling to breathe due to excess lung secretions, all toxic effects of this type of pesticide.[poison.org]
Nausea
  • […] pressure Slow or rapid heart rate Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea Loss of appetite Nausea[medlineplus.gov]
  • Malathion Poisoning According to Oregon State University’s National Pesticide Information Center, people who are exposed to a high enough level of malathion can experience nausea, vomiting, muscle tremors, cramps, weakness, abdominal pain, and diarrhea[decodedscience.org]
  • All sixty developed nausea, vomiting and abdominal pain over the next three hours. They were taken to a local primary healthcare center where they received treatment for their symptoms (intravenous fluids, antiemetics and antibiotics).[panna.org]
  • Side effects of Ivermectin may include dizziness, loss of appetite, nausea, vomiting, stomach pain, diarrhea, constipation, weakness, sleepiness, uncontrollable shaking and chest discomfort. Lindane: Has been banned in over 53 countries.[theliceplace.com]
  • Clinical manifestations caused by organophosphates include hypersalivation, abdominal pain, nausea, vomiting, diarrhea, muscle fasciculations, bradycardia, and hypotension.[jintensivecare.biomedcentral.com]
Hypersalivation
  • In addition, the heart rate increased and hypersalivation was improved after the initiation of HDF. For aspiration-related pneumonia, sulbactam/ampicillin was used.[jintensivecare.biomedcentral.com]
Blurred Vision
  • Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock.[openanesthesia.org]
  • There can be many symptoms, though they may not be as clear-cut in children as they are in adults: blurred vision; tearing and sweating; loss of bowel and bladder control; difficulty breathing, as the airway may fill with fluid; tremors, muscle twitching[poison.org]
Irritability
  • Neuropsychiatric symptoms include fatigue, anxiety, irritability, confusion, lethargy, cognitive impairment, loss of consciousness, and possibly coma.[symptoma.com]
  • Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more.[nytimes.com]
  • Irritation where malathion is used. What are some other side effects of Malathion? All drugs may cause side effects. However, many people have no side effects or only have minor side effects.[drugs.com]
Headache
  • THROAT Increased salivation Increased tears in the eyes Small or dilated pupils that do not react to light HEART AND BLOOD Low or high blood pressure Slow or rapid heart rate Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache[medlineplus.gov]
Slurred Speech
  • Patients may exhibit pinpoint pupils, slurred speech, gait ataxia, and a broad range of neurologic, respiratory, and behavioral symptoms.[symptoma.com]
Gait Ataxia
  • Patients may exhibit pinpoint pupils, slurred speech, gait ataxia, and a broad range of neurologic, respiratory, and behavioral symptoms.[symptoma.com]
Lethargy
  • Neuropsychiatric symptoms include fatigue, anxiety, irritability, confusion, lethargy, cognitive impairment, loss of consciousness, and possibly coma.[symptoma.com]

Workup

When evaluating a patient with clinical features suspicious for organophosphate poisoning, the medical team should assess and manage the patient urgently. The clinicians must inquire about the exposure route and the amount of malathion while also obtaining the history and conducting the physical exam. The diagnosis is mainly clinical but malathion poisoning is confirmed through the appropriate studies.

Laboratory tests

The definitive diagnostic tool is the measurement of cholinesterase activity. There are two types of assays, butyrylcholinesterase (also referred to as plasma cholinesterase and pseudocholinesterase) and red blood cell (RBC) acetylcholinesterase [10]. The activity of the former does not correlate to the clinical severity [10]. However, RBC acetylcholinesterase is likely a good indicator of the severity [11].

A comprehensive workup will also include a complete blood count (CBC) and complete metabolic panel (CMP), which would reveal leukocytosis, hypokalemia, hypomagnesemia, hyperglycemia [12], increased liver function tests (LFTs), and elevated amylase [1]. Furthermore, an arterial blood gas (ABG) is crucial; this will demonstrate respiratory and/or metabolic acidosis. Additionally, myocardial enzymes will show elevated troponin [13].

Imaging

The clinical manifestations will reflect which imaging modalities should be performed. For example, respiratory symptoms are investigated with a chest x-ray, which displays pulmonary edema in affected patients.

Other

Since cardiac involvement is common, an electrocardiogram (EKG) is an essential study. Abnormalities may include ST segment changes [13], inverted T waves, torsade de points and ventricular fibrillation [14]. Sinus tachycardia is a frequent finding initially, but this transforms to sinus bradycardia as the toxicity progresses.

Treatment

Etiology

  • Methomyl-induced severe acute pancreatitis: possible etiological association. JOP. 2005;6(2):166–71. PubMed Google Scholar Lambert H. Electrocardiographic changes in acute pancreatitis. Cardiologia. 1966;48(4):387–90.[jintensivecare.biomedcentral.com]

Epidemiology

  • Describes everything you need to know about Organophosphates and Carbamates Extensively covers pesticides, nerve agents, therapeutic drugs, and flame retardants Describes epidemiology of the world's major disasters involving Organophosphates and Carbamates[books.google.ro]
Sex distribution
Age distribution

Prevention

  • You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible.[medlineplus.gov]
  • The technology to prevent bee kills exists, but cooperation between the farmer and beekeeper is necessary to prevent damage from pesticides.[www1.agric.gov.ab.ca]
  • Benzyl Alcohol: Sold under the name Ulesfia , this product will smother the adult lice by preventing them from shutting down their spiracles. Direct contact with each bug for a minimum of 10 minutes is required.[theliceplace.com]
  • Severe poisonings can be difficult to treat and recovery can be prolonged, making prevention of poisoning very important.[poison.org]
  • Atlanta: Centers for Disease Control and Prevention , 2001. 2. Metsaars MAJ, Takken W, Meer G de. Hoofdluisinfecties en het falen van anti-hoofdluismiddelen in Nederland. TSG 2000; 78: 401-405. 3. Roberts RJ. Clinical practice. Head lice.[geneesmiddelenbulletin.com]

Patient Information

References

Article

  1. Yurumez Y, Durukan P, Yavuz Y, et al. Acute organophosphate poisoning in university hospital emergency room patients. Intern Med. 2007; 46(13):965-9.
  2. Levy-Khademi F, Tenenbaum AN, Wexler ID, Amitai Y. Unintentional organophosphate intoxication in children. Pediatr Emerg Care. 2007;23(10):716-8.
  3. Singh S, Sharma N. Neurological syndromes following organophosphate poisoning. Neurol India. 2000;48(4):308–13.
  4. Eddleston M, Mohamed F, Davies JO, et al. Respiratory Failure in Acute Organophosphorus Pesticide Self-Poisoning. QJM. 2006;99(8):513-522.
  5. Saadeh AM, Farsakh NA, al-Ali MK. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart. 1997;77(5):461-464.
  6. Ohtani T, Iwanami A, Kasai K, et al. Post-traumatic stress disorder symptoms in victims of Tokyo subway attack: a 5-year follow-up study. Psychiatry Clin Neurosci. 2004;58(6):624-9.
  7. Jokanovic M, Kosanovic M. Neurotoxic effects in patients poisoned with organophosphorus pesticides. Environ Toxicol Pharmacol. 2010;29(3):195–201.
  8. Fukushima H, Watanabe T, Asai H, et al. Out-of-hospital cardiac arrest caused by acute intoxication. Chudoku Kenkyu. 2010; 23(1):41-6.
  9. Aghabiklooei A, Mostafazadeh B, Farzaneh E, Morteza A. Does organophosphate poisoning cause cardiac injury? Pak J Pharm Sci. 2013; 26(6):1247-50.
  10. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9612):597-607.
  11. Thiermann H, Szinicz L, Eyer P, Zilker T, Worek F. Correlation between red blood cell acetylcholinesterase activity and neuromuscular transmission in organophosphate poisoning. Chem Biol Interact. 2005;157–58:345–347.
  12. Saadeh AM. Metabolic complications of organophosphate and carbamate poisoning. Trop Doct. 2001; 31(3):149-52.
  13. Cha YS, Kim H, Go J, et al. Features of myocardial injury in severe organophosphate poisoning. Clin Toxicol (Phila). 2014; 52(8):873-9.
  14. Ludomirsky A, Klein HO, Sarelli P, et al. Q-T prolongation and polymorphous ("torsade de pointes") ventricular arrhythmias associated with organophosphorus insecticide poisoning. Am J Cardiol. 1982;49(7):1654-8.

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Last updated: 2018-06-22 04:36