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Organophosphate Insecticide

Insecticides Organophosphate Antagonists


Presentation

  • Abstract We present a 1 7-year-old female with acute extra-pyramidal parkinsonism complicating a suicidal attempt with the organophosphate insecticide chlorpyrifos, who was initially suspected to have developed severe depression or psychosis.[ncbi.nlm.nih.gov]
  • Abstract A patient is reported presenting a cerebellar disorder developing about 5 weeks after acute exposure to an organophosphate insecticide. Initially no major cholinergic features were observed.[ncbi.nlm.nih.gov]
  • Our patient had developed overt parkinsonism presenting with a resting tremor, expressionless face, and lack of blinking along with marked cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated.[ncbi.nlm.nih.gov]
  • We present the first reported case of acute pancreatitis occurring after cutaneous exposure to an organophosphate insecticide. Symptoms of pancreatitis persisted for 6 months, followed by total resolution.[ncbi.nlm.nih.gov]
  • In El Salvador, occupational exposure to MP in farmers introduced environmental exposures among agricultural families, who presented with the cholinergic features of MP toxicity. Suicidal MP poisoning was reported in Nepal.[ncbi.nlm.nih.gov]
Fatigue
  • Other adverse health effects caused by pesticides include chronic fatigue, asthma, wheeze, immune system disorders, impaired memory, disorientation, depression, irritability, flu-like symptoms, and may increase risk of cancer and Alzheimer's disease.[gdx.net]
  • […] muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue[healthline.com]
Bronchorrhea
  • Treat supportively by giving atropine to relieve bronchospasm and bronchorrhea and by giving 2-PAM to relieve neuromuscular symptoms.[merckmanuals.com]
  • Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures. Immediate aggressive use of atropine may eliminate the need for intubation.[openanesthesia.org]
  • By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools.[omicsgroup.org]
  • ., sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal cramps, and diarrhea.[clinicaladvisor.com]
Rhinorrhea
  • ., sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal cramps, and diarrhea.[clinicaladvisor.com]
Vomiting
  • […] of parenteral injection of organophosphates, attention must be paid to the possibility of late onset of the clinical manifestations of the poisoning, and to the fact that usual measures to reduce exposure to the organophosphate, such as induction of vomiting[ncbi.nlm.nih.gov]
  • Listing individual symptoms emphasized the high prevalence of nonspecific symptoms such as vomiting (142 cases) and abdominal pain (115 cases).[ncbi.nlm.nih.gov]
  • Shortly thereafter, the boy's 10-year-old sister, with the exact same unpleasant odour, altered sensorium, vomiting and respiratory distress, was brought to the emergency department by the father.[intjem.springeropen.com]
  • School authorities stopped serving the meal once the children began vomiting. The school's principal, who went into hiding after the incident, was arrested Tuesday.[cbsnews.com]
  • Here are a few: vomiting, diarrhea, seizures, paralysis, coma, and death. And, this is all caused by messing with a single hydroxyl (OH) group, which is a tiny, but critical portion (the "business end") of acetylcholinesterase.[acsh.org]
Diarrhea
  • Here are a few: vomiting, diarrhea, seizures, paralysis, coma, and death. And, this is all caused by messing with a single hydroxyl (OH) group, which is a tiny, but critical portion (the "business end") of acetylcholinesterase.[acsh.org]
  • […] samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache Dizziness Muscle twitching Poor coordination Vomiting Diarrhea[gdx.net]
  • Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant.[pbs.org]
  • Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic.[medlineplus.gov]
Abdominal Cramps
  • Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant.[pbs.org]
  • During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of[projecttendr.com]
  • Clinically, the patient exhibits excessive salivation, nausea, vomiting, diarrhea, abdominal cramping, and asthmatic symptoms related to a combination of bronchoconstriction and increased respiratory secretions.[path.upmc.edu]
  • Vomiting, abdominal cramps, excessive cold sweating and salivation follow. Giddiness and restlessness may be noticeable. Constriction of the pupils is not always present.[jpma.org.pk]
Nausea
  • […] metabolized into the six dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea[gdx.net]
  • Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic.[medlineplus.gov]
  • Clinically, the patient exhibits excessive salivation, nausea, vomiting, diarrhea, abdominal cramping, and asthmatic symptoms related to a combination of bronchoconstriction and increased respiratory secretions.[path.upmc.edu]
  • Mild organophosphate exposure may cause: narrowed, pinpointed pupils impaired, blurry vision stinging eyes runny nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure[healthline.com]
  • Commonly reported early symptoms include headache, nausea, dizziness, and hypersecretion (i.e., sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal[clinicaladvisor.com]
Abdominal Pain
  • Listing individual symptoms emphasized the high prevalence of nonspecific symptoms such as vomiting (142 cases) and abdominal pain (115 cases).[ncbi.nlm.nih.gov]
  • Symptoms of paradichlorobenzene poisoning: STOMACH AND INTESTINES Diarrhea Abdominal pain Nausea and vomiting MUSCLES Muscle spasms Note: Paradichlorobenzene mothballs are not very toxic.[medlineplus.gov]
  • The most frequent signs are reported to be meiosis, vomiting, hypersalivation, respiratory distress, abdominal pain, and depressed level of consciousness and muscle fasciculation [ 10 ].[ccforum.biomedcentral.com]
Hypersalivation
  • The most frequent signs were meiosis, change in mental status, hypersalivation and fasciculations. Ten patients (21.2%) required mechanical ventilation.[ncbi.nlm.nih.gov]
  • The most frequent clinical signs were meiosis, change in mental status, hypersalivation, agitation and fasciculations (Table 2 ).[ccforum.biomedcentral.com]
  • The physical examination of the boy showed pinpoint pupils (2 mm diameter), hypersalivation and lacrimation. He was responsive to pain, but had slurred speech. His Glasgow Coma Scale (GCS) score was 9.[intjem.springeropen.com]
Drooling
  • […] nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling[healthline.com]
  • […] rate LUNGS AND AIRWAYS Breathing difficulty Wheezing NERVOUS SYSTEM Anxiety Coma (decreased level of consciousness and lack of responsiveness) Convulsions Dizziness Headache Weakness BLADDER AND KIDNEYS Increased urination EYES, EARS, NOSE, AND THROAT Drooling[medlineplus.gov]
Tachycardia
  • Tachycardia, rather than bradycardia, has been noted upon presentation in 49% of children presenting with OI [ 6 ].[intjem.springeropen.com]
  • Tachycardia and mydriasis must not be used to limit or to stop subsequent doses of atropine. The main concern with OP toxicity is respiratory failure from excessive airway secretions.[openanesthesia.org]
  • Two patients who are mechanically ventilated died with sudden car-diorespiratory arrest following ventricular tachycardia, and three died from pneumonia and complicating adult respiratory distress syndrome.[ccforum.biomedcentral.com]
  • Tachycardia, rather than bradycardia, has been noted upon presentation in 49% of children presenting with organophosphate intoxication [ 14 ]. Organophosphate intoxications mostly occur in suicidal intent or by accident.[omicsgroup.org]
Hypotension
  • 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]
  • Most patients have bradycardia and, if poisoning is severe, hypotension. CNS toxicity is common, sometimes with seizures and excitability and often with lethargy and coma.[merckmanuals.com]
Hypertension
  • A wide range of other symptoms may also be noted, including incontinence, defecation, tachycardia, bradycardia, hypertension, cramping of skeletal muscles, bronchospasm, and pulmonary edema.[clinicaladvisor.com]
Miosis
  • The pupillary response (resolution of miosis) is not considered an end point of atropine therapy, as miosis may persist for weeks after significant exposure [ 11 ].[intjem.springeropen.com]
  • Miosis 2. Muscle Twitching and Fasciculations These two are not seen with Flit (2% chlordane with kerosene). Further therapeutic improvement with Atropine Sulphate in cases of organophosphorus insecticides is diagnostic.[jpma.org.pk]
  • Miosis is commonly observed, as are symptoms of central nervous system (CNS) toxicity, such as anxiety and restlessness. Pediatric patients often present with a slightly different clinical picture.[clinicaladvisor.com]
  • Therefore signs such as miosis, increased secretion, bronchospasm, incontinence in urine and stool appeared after a short period. Atropine and the enzyme reactivator obidoxime were given as antidotal therapy for this poisoning.[omicsgroup.org]
Blurred Vision
  • Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant.[pbs.org]
  • 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]
Muscle Twitch
  • […] dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache Dizziness Muscle[gdx.net]
  • […] include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue severe vomiting and diarrhea involuntary urination and defecation[healthline.com]
  • 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]
  • Muscle Twitching and Fasciculations These two are not seen with Flit (2% chlordane with kerosene). Further therapeutic improvement with Atropine Sulphate in cases of organophosphorus insecticides is diagnostic.[jpma.org.pk]
Skeletal Muscle Fasciculation
  • Nicotinic manifestations include increased or decreased muscle power and skeletal muscle fasciculations. Muscarinic manifestations include excessive salivation, meiosis and diarrhea.[ccforum.biomedcentral.com]
Stereotyped Behavior
  • When children were eight years old, we administered the Social Responsiveness Scale (SRS), a continuous measure of various dimensions of interpersonal behavior, communication, and repetitive/stereotypic behaviors.[ncbi.nlm.nih.gov]
Seizure
  • Here are a few: vomiting, diarrhea, seizures, paralysis, coma, and death. And, this is all caused by messing with a single hydroxyl (OH) group, which is a tiny, but critical portion (the "business end") of acetylcholinesterase.[acsh.org]
  • Benzodiazepines are used for seizures. Prophylactic diazepam may help prevent neurocognitive sequelae after moderate to severe organophosphate poisoning.[merckmanuals.com]
  • During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of[projecttendr.com]
  • Drugs can also be given to combat the delirium and seizures associated with the pesticide.[cbsnews.com]
  • Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures. Immediate aggressive use of atropine may eliminate the need for intubation.[openanesthesia.org]
Confusion
  • His 2016 article, "Six Charts Designed to Confuse You," is the seminal work on CDC deception and has been adopted by patient advocacy groups and individuals and has been sent to governors and state legislatures. Dr.[acsh.org]
  • Vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, confusion, numbness, twitching, paralysis, death. Suspected Health Effects: Brain, nervous system damage. Endocrine disrupter. Liver, respiratory system toxicant.[pbs.org]
  • During an acute poisoning incident, the enzyme is suppressed and nerve impulses fire uncontrollably, resulting in symptoms such as muscle spasms, confusion, dizziness, loss of consciousness, seizures, abdominal cramps, vomiting, diarrhea, cessation of[projecttendr.com]
  • 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]
Tremor
  • […] toxogonin treatment along with mechanical ventilation she developed overt extrapyramidal parkinsonism and encephalopathy, characterized by impaired sensorium and agitation, mask facies along with a muffled voice and swallowing impairment, a resting tremor[ncbi.nlm.nih.gov]
  • Our patient had developed overt parkinsonism presenting with a resting tremor, expressionless face, and lack of blinking along with marked cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated.[ncbi.nlm.nih.gov]
  • […] nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors[healthline.com]
  • In higher doses, people may suffer from vomiting, diarrhea, abdominal cramps, dizziness, eye pain, blurred vision, slurred speech, loss of reflexes, twitching, tremors of the tongue or eyelids, and eventually, paralysis of the body extremities and the[pbs.org]
Headache
  • The patient's symptoms, the recovery after atropine administration and the occurrence of headache in the involved health care personnel indicated probable OI.[intjem.springeropen.com]
  • […] metabolized into the six dialkyl phosphates that show up in urine samples: Dimethylthiophosphate (DMTP) Dimethyldithiophosphate (DMDTP) Diethylthiophosphate (DETP) Diethyldithiophosphate (DEDTP) Symptoms of Organophosphate Pesticide Exposure Include: Nausea Headache[gdx.net]
  • Mild organophosphate exposure may cause: narrowed, pinpointed pupils impaired, blurry vision stinging eyes runny nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure[healthline.com]
  • Chronic exposure may lead to disorientation, severe depression, irritability, confusion, headache, speech difficulties, delayed reaction times, nightmares, sleepwalking and drowsiness or insomnia, as well as numbness, cramping and weakness in the legs[pbs.org]
Irritability
  • Other adverse health effects caused by pesticides include chronic fatigue, asthma, wheeze, immune system disorders, impaired memory, disorientation, depression, irritability, flu-like symptoms, and may increase risk of cancer and Alzheimer's disease.[gdx.net]
  • Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest.[omicsgroup.org]
  • Chronic exposure may lead to disorientation, severe depression, irritability, confusion, headache, speech difficulties, delayed reaction times, nightmares, sleepwalking and drowsiness or insomnia, as well as numbness, cramping and weakness in the legs[pbs.org]

Workup

Torsades De Pointes
  • Torsades de Pointes should be treated in the standard manner. The use of intravenous magnesium sulfate has been reported as beneficial for organophosphate toxicity.[openanesthesia.org]

Treatment

  • The signs and symptoms of acute poisoning are described and a rational approach to specific treatment is discussed.[ncbi.nlm.nih.gov]
  • Early diagnosis and appropriate treatment is often life saving. Treatment of OP poisoning consists of intravenous atropine and oximes. The clinical course of OP poisoning may be quite severe and may need intensive care management.[ncbi.nlm.nih.gov]
  • The value of pralidoxime as a reactivator of phosphorylated cholinesterases is therefore in doubt, and should not be used in preference to large doses of atropine and other supportive treatment in poisoning by organophosphate insecticides.[ncbi.nlm.nih.gov]
  • Following atropine and toxogonin treatment along with mechanical ventilation she developed overt extrapyramidal parkinsonism and encephalopathy, characterized by impaired sensorium and agitation, mask facies along with a muffled voice and swallowing impairment[ncbi.nlm.nih.gov]
  • Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. British Journal of Clinical Pharmacology. 2015; 81(3):462–70. doi: 10.1111/bcp.12784[journals.sbmu.ac.ir]

Prognosis

  • The prognosis of IMS, however, is likely to be favorable if respiratory failure can be promptly recognized and treated accordingly.[ncbi.nlm.nih.gov]
  • Lancet 2008, 371: 597–607. 10.1016/S0140-6736(07)61202-1 PubMed Central View Article PubMed Google Scholar Aygun D: Serum acetylcholinesterase and prognosis of acute organophosphate poisoning.[intjem.springeropen.com]
  • Aygun D, Doganay Z, Altinop L, Guven H, Onar M, et al. (2002) Serum acetylcholinesterase and prognosis of acute organophosphate poisoning.J Toxicol Clin Toxicol 40: 903–910. Leibson T, Lifshitz M (2008) Organophosphate and carbamate poisoning.[omicsgroup.org]

Etiology

  • Although IMS is well recognized as a disorder of neuromuscular junctions, its exact etiology, incidence, and risk factors are not clearly defined because existing studies are largely small-scale case series and do not employ a consistent and rigorous[ncbi.nlm.nih.gov]

Epidemiology

  • BACKGROUND AND AIM: Epidemiological studies linking insecticide exposure to childhood neurodevelopment have been gaining global attention.[ncbi.nlm.nih.gov]
  • OBJECTIVE: Diazinon, a common organophosphate insecticide with genotoxic properties, was previously associated with lung cancer in the Agricultural Health Study (AHS) cohort, but few other epidemiological studies have examined diazinon-associated cancer[ncbi.nlm.nih.gov]
  • OPs have been linked to cancer risk in some epidemiological studies, which have been largely conducted in predominantly male populations.[ncbi.nlm.nih.gov]
  • 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.com]
  • An epidemiological study of poisoning in northern Islamic Republic of Iran. Eastern Mediterranean Health Journal. 2002; 8(1):88-94. PMID: 15330564 Nambiar MP, Gordon RK, Rezk PE, Katos AM, Wajda NA, Moran TS, et al.[journals.sbmu.ac.ir]
Sex distribution
Age distribution

Pathophysiology

  • Despite a high incidence, the pathophysiology that underlies IMS remains unclear.[ncbi.nlm.nih.gov]

Prevention

  • Thus, administration of a drug such as amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae.[ncbi.nlm.nih.gov]
  • Preventive measures in reducing the use of toxic chemicals should be taken seriously to protect human health and the environment.[ncbi.nlm.nih.gov]
  • In experiment 4, to determine whether enzyme activities were still inhibited if lipid peroxidation was prevented by exogenous antioxidants, experiment 1 was repeated with the CE concentrations of 0.01, 0.1, 0.4, and 10 g/l by adding butylated hydroxytoluene[ncbi.nlm.nih.gov]
  • Successful examples include reducing dust in orchards to prevent the buildup of spider mites, and the cleanup of unharvested grapes to limit overwintering pests. * Less toxic, more pest-specific alternative insecticides, such as pyrethroids, neonicotinoids[sciencedaily.com]
  • In severe cases, doctors often prescribe benzodiazepines to prevent or stop seizures.[healthline.com]

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