Organochlorine Pesticide Toxicity Treatment & Management

  • Author: Jennifer Vyse Pope, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 11, 2010
 

Prehospital Care

  • Dermal decontamination is a priority.
    • Remove clothes.
    • Wash skin with soap and water.
  • Provide oxygen and supportive care as necessary.
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Emergency Department Care

  • Dermal decontamination: Removes clothes and wash skin with soap and water.
  • GI decontamination
    • Insertion of a nasogastric tube for stomach evacuation is controversial; it may induce vomiting with subsequent aspiration. If nasogastric suction is used, a small-bore tube should be used.
    • Activated charcoal can be used but with caution because patients are at increased risk for seizures[11] and consequent aspiration.
    • Cholestyramine may be used alternatively to bind these highly lipophilic agents. It reduces reabsorption and retains bound agent in the GI tract for fecal elimination.[12]
    • Following ingestion of chlordecone, multiple repeated doses of cholestyramine can be administered to interrupt enteroenteric and enterohepatic recirculation.[13]
    • Sucrose polyester (olestra) has also been shown to increase excretion of fat-soluble organic chlorine chemicals.[14]
  • Benzodiazepines or barbiturates, GABA agonists, are indicated for treatment of seizures. Propofol can be used as second-tier agent for the control of persistent seizures.
  • Cardiac monitoring is indicated.
  • Use epinephrine and sympathomimetic amines with caution because dysrhythmias can be induced.
  • The use of steroids or prophylactic antibiotics for aspiration is controversial and cannot be recommended because of a lack of evidence for their efficacy.
  • Hyperthermia, lactic acidosis, and muscle destruction may be treated with neuromuscular blocking agents.
  • External cooling may be used for hyperthermia.
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Consultations

Consult a poison control center and/or a medical toxicologist for information regarding the specific ingestion.

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Contributor Information and Disclosures
Author

Jennifer Vyse Pope, MD  Staff Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center

Jennifer Vyse Pope, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Morgan Skurky-Thomas, MD  Resident Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School

Morgan Skurky-Thomas, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Carlo L Rosen, MD  Associate Professor of Medicine, Harvard Medical School; Program Director, Vice Chair for Education, Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Affiliated Emergency Medicine Residency program

Carlo L Rosen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Bhalla M, Thami GP. Reversible neurotoxicity after an overdose of topical lindane in an infant. Pediatr Dermatol. Sep-Oct 2004;21(5):597-9. [Medline].

  2. Reigart JR, Roberts JR, eds. Recognition and Management of Pesticide Poisonings. 5th ed. Washington DC: Environmental Protection Agency; 1999.

  3. Centers for Disease Control and Prevention. Acute convulsions associated with endrin poisoning--Pakistan. MMWR Morb Mortal Wkly Rep. Dec 14 1984;33(49):687-8, 693. [Medline].

  4. Pramanik AK, Hansen RC. Transcutaneous gamma benzene hexachloride absorption and toxicity in infants and children. Arch Dermatol. Oct 1979;115(10):1224-5. [Medline].

  5. Mortensen ML. Management of acute childhood poisonings caused by selected insecticides and herbicides. Pediatr Clin North Am. Apr 1986;33(2):421-45. [Medline].

  6. Kanthasamy AG, Kitazawa M, Kaul S, Yang Y, Lahiri DK, Anantharam V. Proteolytic activation of proapoptotic kinase PKCdelta is regulated by overexpression of Bcl-2: implications for oxidative stress and environmental factors in Parkinson's disease. Ann N Y Acad Sci. Dec 2003;1010:683-6. [Medline].

  7. Kintz P, Baron L, Tracqui A, Peton P, Coudane H, Mangin P. A high endrin concentration in a fatal case. Forensic Sci Int. May 1992;54(2):177-80. [Medline].

  8. van der Hoek W, Konradsen F. Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health. Jun 2005;10(6):589-96. [Medline].

  9. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  10. Dally S, Garnier R, Bismuth C. Diagnosis of chlorinated hydrocarbon poisoning by x ray examination. Br J Ind Med. Jun 1987;44(6):424-5. [Medline].

  11. Morgan DP, Dotson TB, Lin LI. Effectiveness of activated charcoal, mineral oil, and castor oil in limiting gastrointestinal absorption of a chlorinated hydrocarbon pesticide. Clin Toxicol. 1977;11(1):61-70. [Medline].

  12. Kassner JT, Maher TJ, Hull KM, Woolf AD. Cholestyramine as an adsorbent in acute lindane poisoning: a murine model. Ann Emerg Med. Sep 1993;22(9):1392-7. [Medline].

  13. Cohn WJ, Boylan JJ, Blanke RV, Fariss MW, Howell JR, Guzelian PS. Treatment of chlordecone (Kepone) toxicity with cholestyramine. Results of a controlled clinical trial. N Engl J Med. Feb 2 1978;298(5):243-8. [Medline].

  14. Mutter LC, Blanke RV, Jandacek RJ, Guzelian PS. Reduction in the body content of DDE in the Mongolian gerbil treated with sucrose polyester and caloric restriction. Toxicol Appl Pharmacol. Mar 15 1988;92(3):428-35. [Medline].

  15. Ecobichon DJ. Toxic effects of pesticides. In: Casarett & Doull's Toxicology: The Basic Science of Poisons. Vol 22. 2001:769.

  16. Ellenhorn MJ, ed. Pesticides. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. Williams & Wilkins; 1997:1614-5.

  17. Holland MG. Insecticides: Organic chlorines, pyrethrins/pyrethroids, and DEET. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, et al. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006:Chap 110.

  18. Jandacek RJ, Anderson N, Liu M, Zheng S, Yang Q, Tso P. Effects of yo-yo diet, caloric restriction, and olestra on tissue distribution of hexachlorobenzene. Am J Physiol Gastrointest Liver Physiol. Feb 2005;288(2):G292-9. [Medline].

  19. Kilburn KH, Thornton JC. Protracted neurotoxicity from chlordane sprayed to kill termites. Environ Health Perspect. Jul-Aug 1995;103(7-8):690-4. [Medline].

  20. Leach GJ, Russell RD, Houpt JT. Some cardiovascular effects of the insect repellent N,N-diethyl-m-toluamide (DEET). J Toxicol Environ Health. 1988;25(2):217-25. [Medline].

  21. Mutter LC, Blanke RV, Jandacek RJ, Guzelian PS. Reduction in the body content of DDE in the Mongolian gerbil treated with sucrose polyester and caloric restriction. Toxicol Appl Pharmacol. Mar 15 1988;92(3):428-35. [Medline].

  22. Narahashi T, Frey JM, Ginsburg KS, Roy ML. Sodium and GABA-activated channels as the targets of pyrethroids and cyclodienes. Toxicol Lett. Dec 1992;64-65 Spec No:429-36. [Medline].

  23. Olson KR. Hydrocarbons. In: Poisoning and Drug Overdose. 2nd ed. Appleton & Lange; 1994:178-80.

  24. Song JH, Nagata K, Tatebayashi H, Narahashi T. Interactions of tetramethrin, fenvalerate and DDT at the sodium channel in rat dorsal root ganglion neurons. Brain Res. Feb 5 1996;708(1-2):29-37. [Medline].

  25. Woo OF. Chlorinated hydrocarbon pesticides. In: Poisoning and Drug Overdose. 2nd ed. Appleton & Lange; 1994:129-30.

 
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