Toxaphene Toxicity Clinical Presentation
- Author: Girish Sethuraman, MD, MPH; Chief Editor: Asim Tarabar, MD more...
History
Obtaining a thorough history is essential to the diagnosis of toxaphene poisoning. At a minimum, the history should include the following:
- Prior medical and psychiatry history
- Nonprescription drugs used
- Natural or herbal preparations used
- Allergies to medications
- Patient activity for that day of exposure
- Occupational history, including farming, field work, and chemical or pesticide manufacturing, handling, or application
- Pest control use
- Location in relation to industrial facilities or waste sites
- Hobbies (eg, gardening)
If possible, obtaining the product in its original container is important. Review the label and contact the poison control center. Save the sample for possible testing and identification. Usually, testing has to be performed at an outside laboratory and has no immediate clinical impact on the patient's treatment.
Under the Federal Pesticide Act of 1962, the package label must contain certain information regarding product classification and toxicity, which is based on animal oral LD50 studies.
The following are classifications for the toxic categories:
- Danger - High toxicity
- Warning - Moderate toxicity
- Caution - Low toxicity
- No signal word - Safe
Physical
Perform a carefully directed physical examination and look for clues (eg, odor, injuries, neurological findings), which can help in determining type of exposure, underlying medical condition, or concomitant trauma. Look for signs of a toxidrome. In patients with agricultural or occupational exposure, concomitant organophosphorus or carbamate poisoning is common.
Repeated assessments of the ABCs and all vital signs are of extreme importance for proper treatment of patients with acute poisoning.
Generally, onset of symptoms is characteristically abrupt and is mainly caused by CNS stimulation and lowering of the seizure threshold.
Patients with significant exposure usually develop nausea and vomiting, followed by confusion, tremors, coma, seizures, and respiratory depression. Fatality usually occurs within 4-8 hours because of respiratory failure and the sequelae of metabolic acidosis secondary to prolonged seizure activity.
The first manifestation of toxicity may be a seizure without any prodromal signs or symptoms. Generalized convulsions should suggest severe exposure.
Seizures often develop within 1-2 hours when ingested on an empty stomach and as late as 5-6 hours on a full stomach. Strong external stimuli and reflex hyperexcitability may precipitate muscle fasciculations and tonic spasms, which may evolve into seizures.
In addition, the myocardium could become oversensitized to dysrhythmogenic effects of endogenous catecholamines. Cyanosis has been reported to appear before convulsions at least once.
Possible acute clinical findings that may be encountered include the following:
- Mild dermal irritation (in dermal exposure)
- Anorexia, nausea, and vomiting
- Paresthesia of the tongue, lips, and face
- Behavioral changes (eg, confusion, restlessness, apprehension, irritability)
- Movement disorders (eg, involuntary movements, tremor, dystaxia)
- Convulsions and status epilepticus
- Hypersusceptibility to stimuli, hyperreflexia, and sustained ankle clonus
- Coma (cerebral edema noted postmortem)
- Respiratory failure (aspiration pneumonitis, prolonged seizures)
- Liver cell necrosis (secondary to toxic metabolites)
- Hyperthermia (from protracted muscle fasciculations, clonic movements, and agitation or prolonged seizure activity)
Patients with long-term occupational exposure to organochlorine pesticides may develop various nonspecific symptoms, including headaches, nausea, fatigue, muscle twitching, and visual disturbances. In addition, chronic exposure to these agents may be associated with the development of blood dyscrasias, including aplastic anemia and leukemia in humans (inconclusive).
Some epidemiologic evidence suggests that organochlorines may be carcinogenic in humans. The EPA classifies these agents as probable human carcinogens.
Results of epidemiologic studies have been inconsistent.
Toxaphene interferes directly or indirectly with fertility and reproduction in rodents (testicular degeneration and endocrine changes). Toxaphene is teratogenic in mice and rats at doses that result in overt maternal toxicity. Also, tumors arise in the liver (eg, hepatomas) and renal tubules of chronically exposed animals.
Causes
- Acute exposure (unintentional or intentional)
- Chronic low-grade exposure
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