Toxaphene Toxicity Workup

  • Author: Girish Sethuraman, MD, MPH; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Feb 9, 2011
 

Laboratory Studies

  • Glucose (bedside fingerstick) testing
  • ABG testing (pH and ventilation status) in patients with respiratory distress or evidence of acidosis
  • Serum electrolytes testing
  • Renal profile
  • Liver function tests (LFTs)
  • CBC count
  • Urinalysis (indirect check for myoglobinuria)
  • Creatinine kinase (CK) testing
  • Urine or serum pregnancy test if indicated
  • Plasma and RBC cholinesterase testing in cases in which organophosphorous compound coexposure may have occurred or if offending toxicant has not been determined and the patient presents with signs or symptoms consistent with cholinergic toxidrome
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Imaging Studies

  • Abdominal radiography may be indicated in ingestion because chlorinated pesticides are usually radiopaque. Negative radiography findings do not rule out significant exposure.
  • Chest radiography may be indicated to rule out aspiration.
  • CT scanning of the head may be indicated to rule out intracranial pathology (eg, masses, focal edema, traumatic or nontraumatic intracerebral bleeds). In severe exposures to toxaphene, diffuse cerebral edema has been reported.
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Other Tests

  • Generally, toxaphene whole blood levels document exposure, but these levels do not correlate well with the degree of toxicity.
  • No specific method is available for detection of the hundreds or thousands of compounds in toxaphene-derived residues.
  • If necessary, gas chromatographic analytical studies of serum, adipose tissue, urine, and breast milk can be considered for documentation of exposure.
  • For occupational purposes, performing adipose tissue biopsy testing for estimating total body burden of an exposed population is possible. This has no application in acute treatment of the exposed patient.
  • For the emergency department clinician, the above studies are unlikely to be of any acute clinical value because the likelihood of a rapid test result is small. However, obtaining samples for these examinations may be valuable for the extended-term evaluation and treatment of the patient.
  • Electrocardiography may be indicated.
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Procedures

  • In a postmortem forensic examination, brain analytical studies are warranted because severity of toxicity correlates with CNS concentration of these insecticides. Therefore, when a patient's death possibly is caused by acute or chronic pesticide exposure, alert the coroner so that appropriate safety issues may be addressed. This action is especially important in occupationally related cases.
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Contributor Information and Disclosures
Author

Girish Sethuraman, MD, MPH  Assistant Professor, University of Maryland School of Medicine

Girish Sethuraman, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM  Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

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.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

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

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