Insecticide Poisoning

Br J Psychiatry. Author manuscript; available in PMC 2008 Aug 1.

Published in final edited form as:

doi: 10.1192/bjp.bp.105.020834

Most serious insecticide poisonings result from the organophosphate and carbamate types of insecticides, particularly when used in suicide attempts and, when accidental, in occupational settings. Organophosphates include malathion, parathion, fenthion, dursban, diazinon, chlorpyrifos, and sarin. We monitor trends in pesticide-related illnesses and injuries through the SENSOR-Pesticides program. We also use data from the National Poison Data System (NPDS) to track work-related acute pesticide poisonings. This kind of surveillance also serves as an early warning system of any harmful effects not detected by pesticide manufacturer testing.

EMSID: UKMS1629

The publisher's final edited version of this article is available at Br J Psychiatry

See other articles in PMC that cite the published article.

Abstract

Self-poisoning with pesticides accounts for around a third of all suicides worldwide. To tackle this problem, WHO announced a Global Public Health initiative in 2005. Planned approaches will range from Government regulatory action to the development of new treatments for pesticide poisoning. With broad-based support this strategy will have a major impact on the global burden of suicide.

Suicide is an important cause of premature mortality accounting for an estimated 849,000 deaths every year (). In many agricultural communities of low- and middle-income countries pesticide self-poisoning accounts for many of these deaths (). In 1985, based on data from Sri Lanka, Jeyaratnam estimated there were approximately 2.9 million cases of acute pesticide poisoning, resulting in around 220,000 deaths each year in the developing world (). More recently, based on the finding that pesticide ingestion accounted for over 60% of suicides in many rural areas of China and South-East Asia, estimated that there may be as many as 300,000 deaths each year from intentional poisoning (i.e. suicide by ingestion of pesticides) in these regions alone. This makes it likely that pesticide poisoning is the most frequently used method of suicide worldwide.

The research and policy attention pesticide poisoning has received has been relatively small in comparison to the magnitude of the problem (; ). suggested that part of the reason pesticide poisoning had not received the global attention it deserved was the lack of scientific evidence concerning the extent of the problem. Even though a global estimate is still not possible today, due to the lack of large-scale, rigorous surveillance data, evidence is growing that the burden of pesticide poisoning has by no means been underestimated. Whilst data from low income countries in South America and Africa is less comprehensive than that from China and South East Asia, evidence is emerging that pesticide poisoning is equally important in such settings. In Brazil, for example, the high suicide rates in tobacco growing regions may be due to the wide use and availability of pesticides (Csillag, 1996). Furthermore, pesticides accounted for 18% of male and 7% of female hospital admissions for self-harm in Campinas, Brazil in 2002-4 (). In Southern Trinidad over 80% of suicides in one rural area were due to pesticide poisoning (). In Suriname a high proportion of both fatal (55%) and non-fatal (44%) episodes of suicidal behaviour involve pesticides (). In Africa, data from Zimbabwe show rising levels of admissions for organophosphate self-poisoning: self-poisoning accounted for around three quarters of the approximately 200 admissions in one study (). More recently data from Malawi implicated pesticide self-poisoning in almost 80% of suicides ().

Despite the problems in estimating the global burden of pesticide poisoning, we may safely assume that we are confronted with millions of cases of pesticide poisoning, hundreds of thousands of which result in deaths each year in low- and middle income countries. There is an urgent need for immediate action.

Approaches to suicide prevention

Two of the major components of current international suicide prevention strategies are the improved recognition and treatment of mental illness and restricting access to commonly used methods of suicide (WHO, 2004).

Mental disorders are found less frequently in suicides in Asian than in Western countries, possibly because a greater proportion of deaths in Asia result from the use of highly lethal pesticides in impulsive acts of self-harm. Nevertheless mental illness is present in a significant proportion of Asian suicides () and is thought to play an important role in suicidal behaviours, underlining the role of mental health workers in these settings.

Epidemiological evidence demonstrates that restricting access to commonly used methods of suicide may lead to reductions in overall as well as method-specific suicide rates. The potential impact of changing the availability of pesticides on both pesticide poisoning and overall suicide numbers has been demonstrated in Western Samoa (Bowles, 1995). Furthermore, the benefits of restricting pesticide use to those least harmful to humans in self-poisoning is demonstrated by the widely differing case fatality rates associated with different pesticides - from >60% for paraquat () to <10% for several products (;). Likewise, just as the development and widespread use of N-acetyl cysteine had a dramatic effect on trends in paracetamol mortality in the England & Wales () so too may the development of new antidotes to pesticide self-poisoning reduce suicides in low and middle income countries. International research in this area should be a global priority (). However, to date, the global response to the problem of self-poisoning with pesticides has been poor.

An intersectoral global public health initiative

In collaboration with other relevant UN agencies, governments, academic institutions, non-governmental organizations and interested parties, WHO has announced an intersectoral global public health initiative with the overall goal of reducing morbidity and mortality related to pesticide poisoning, adhering to a strategy of concerted action at various levels. The five objectives of the programme are:

Review and recommend improved pesticide regulatory policies;
Implement sustainable epidemiological surveillance and monitoring of pesticide poisoning in clinical settings and communities;
Improve the medical management and mental health care of people with pesticide poisoning in health care facilities at different levels;
Provide training in the safe handling, identification and management of pesticide poisoning at different sectors and levels;
Develop or strengthen community programmes that minimize risks of intentional and unintentional pesticide poisoning.

There are three components to WHO’s strategy. First, to establish sentinel projects in selected countries with a high burden of intentional and unintentional pesticide poisoning. Second, to establish regional centres, associated with the sentinel project sites, for the prevention and management of pesticide poisoning, and for enhanced surveillance, training, and community action. Third, to disseminate information to governments, decision makers and the public at large about insights, experience, and lessons learnt from research, formulated as recommendations to guide global policy and local action for the prevention and management of pesticide poisoning.

When suicidal behaviour plays an important role in non-fatal and fatal self-poisoning by pesticides, it is key that relevant preventive measures are anchored in national suicide prevention programmes; these, unfortunately, mostly do not exist as yet in low- and middle income countries. To this end, WHO has started to work with governments worldwide to raise awareness of the importance and magnitude of suicidal behaviours and to provide technical assistance in the development and implementation of national strategies for suicide prevention.

It is crucial that governments ratify and enforce the Hazardous Chemicals and Wastes Conventions, i.e. the Basel, Rotterdam, and Stockholm Conventions. The majority of countries where pesticide poisoning is a major problem have not done so (). Together, these Conventions cover key elements of the management of hazardous chemicals, most comprehensively in the case of Persistent Organic Pollutants (POPs), which are covered by all three treaties (www.basel.int; www.pic.int; www.pops.int; last accessed on 21 February 2006).

Closing remarks

The available data suggest that acute pesticide poisoning has been a major problem in developing countries for many years and that it should be a major public health concern today. argued 20 years ago that most research studies and publications on the impact of pesticides on health concentrated on aspects relevant to the industrialized world and that the industrialized countries have in fact been able to successfully control pesticide poisoning.

Although little has been done in developing countries, there is encouraging work in progress. Pilot studies are underway in some areas of China and Sri Lanka to assess the effect on suicide and suicide attempts in rural areas of the adoption by farmers of a double locked box where pesticides are stored. In Sri Lanka the Non-Governmental Organisation (NGO) Sumithrayo and other groups are active in evaluating interventions of this sort. Early results from one group working on the feasibility of locked boxes in Sri Lanka suggest that this is a practical approach to pursue, if developed in collaboration with local communities, signalling the importance of large scale evaluations (personal communication: Flemming Konradsen). With creativity, willingness and appropriate funds much can be done to prevent this unnecessary loss life.

Considerable work is still required to determine the appropriate balance between public health approaches to reduce pesticide poisoning and the need for crop protection products by the agricultural sector.

Action has to be effective at least in the areas of pesticide policy, pesticide information, mental health care, clinical management of pesticide intoxication and restricting hazardous exposure to pesticides. In view of the complexity and novelty of many of these areas, a solid yet feasible research programme has to back them. This will only succeed if a broad intersectoral and financial support is made available, involving the governmental and the private sector, including relevant NGOs and agencies of the UN System.

References

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Medically reviewed by Drugs.com. Last updated on Jul 10, 2019.

Dosage

Applies to the following strengths: 0.4 mg/mL; 0.1 mg/mL; 0.05 mg/mL; 1 mg/mL; 0.5 mg/mL; 0.8 mg/mL; 0.4 mg; 0.4 mg/mL-NaCl 0.9%

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Bradyarrhythmia

0.4 to 1 mg, IV, every 1 to 2 hours as needed
-Larger doses, up to a maximum of 2 mg, may be required
Use: To overcome severe bradycardia and syncope due to a hyperactive carotid sinus reflex

Usual Adult Dose for Anesthesia

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously
Comments:
-Doses may be considerably exceeded in certain cases.
Uses:
-Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
-Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
-Relieve hypertonicity of the uterine muscle
-Relax the spasm of biliary and ureter colic and bronchial spasm
-Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
-Control the crying and laughing episode in patients with brain lesions
-Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
-Management of peptic ulcer
-In anesthesia to control excessive salivation and bronchial secretions
-Control rhinorrhea of acute rhinitis or hay fever
-Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
-To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Anticholinesterase Poisoning

Usual Adult Dose for Rhinorrhea

Usual Adult Dose for AV Heart Block

Usual Adult Dose for Head Injury

Usual Adult Dose for Peptic Ulcer

Usual Adult Dose for Organophosphate Poisoning

0.8 mg, IM
-If no apparent effect within 30 minutes OR definite poisoning symptoms occur (nausea, vomiting, diarrhea, pupillary constriction, pulmonary edema, fasciculations of eyelids and tongue, jerky ocular movements and excessive sweating, salivation and bronchial secretion): Give 2 mg, IM, every hour, until signs of atropinization are seen
-The 2 mg dose may need to be given 2 or 3 times (4 to 6 mg total) in severe cases
Auto-injector:
2 or more mild symptoms of exposure: One 2 mg dose
Severe symptoms: One 2 mg dose, followed by two additional 2 mg injections given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three 2 mg doses into the mid-lateral thigh in rapid succession
Mild symptoms:
-Blurred vision, miosis
-Excessive unexplained teary eyes
-Excessive unexplained runny nose
-Increased salivation such as sudden unexplained excessive drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing or coughing
-Acute onset of stomach cramps
-Tachycardia or bradycardia
Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or severe secretions from the lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defecation
-Convulsions
-Unconsciousness
Comments:
-These doses may be considerably exceeded in certain cases.
-Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
-Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
-Immediate evacuation from the contaminated environment is essential.
-Decontaminate the poisoned individual as soon as possible.
-The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
-Pralidoxime chloride may serve as an important adjunct to atropine therapy.
-The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
-Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
-In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
-It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
-Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.
Uses: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Usual Adult Dose for Nerve Agent Poisoning

Usual Adult Dose for Radiographic Exam

1 mg, IM
Use: Relaxation of the upper gastrointestinal tract and colon during radiography

Usual Pediatric Dose for Anesthesia

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously
17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously
24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously
40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously
65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously
Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously
Comments:
-Doses may be considerably exceeded in certain cases.
Uses:
-Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
-Relieve hypertonicity of the uterine muscle
-Relax the spasm of biliary and ureter colic, and bronchial spasm
-Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
-Control the crying and laughing episodes in patients with brain lesions
-Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
-Management of peptic ulcer
-In anesthesia to control excessive salivation and bronchial secretions
-Control rhinorrhea of acute rhinitis or hay fever
-Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
-Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Anticholinesterase Poisoning

Usual Pediatric Dose for Bradyarrhythmia

Usual Pediatric Dose for Rhinorrhea

Usual Pediatric Dose for AV Heart Block

Usual Pediatric Dose for Head Injury

These characters automatically move, defeating they encounter and passing through levels to reach bosses, but the player can drag them with the mouse in a similar fashion as in, but without the timer on holding the character. The official description of this game is given as 'Adventure of 4 Stickmans!' Stick ranger hacked version. .In the game, the player controls four, each with one of the 8 available classes.

Usual Pediatric Dose for Peptic Ulcer

Usual Pediatric Dose for Organophosphate Poisoning

Auto-injector:
Children weighing over 90 pounds: 2 mg dose
40 to 90 pounds: 1 mg dose
15 to 40 pounds: 0.5 mg dose
Less than 15 pounds: 0.25 mg dose (bunch up thigh to provide a thicker area for injection)
2 or more mild symptoms of exposure: One dose (see weight guide above)
Severe symptoms: One dose, followed by two additional doses given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three doses into the mid-lateral thigh in rapid succession
Mild symptoms:
-Blurred vision, miosis
-Excessive unexplained teary eyes
-Excessive unexplained runny nose
-Increased salivation such as sudden unexplained excessive drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing or coughing
-Acute onset of stomach cramps
-Tachycardia or bradycardia
Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or severe secretions from the lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defecation
-Convulsions
-Unconsciousness
Comments:
-These doses may be considerably exceeded in certain cases.
-Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
-Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
-Immediate evacuation from the contaminated environment is essential.
-Decontaminate the poisoned individual as soon as possible.
-The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
-Pralidoxime chloride may serve as an important adjunct to atropine therapy.
-The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
-Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
-In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
-It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
-Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.
Use: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Usual Pediatric Dose for Nerve Agent Poisoning

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Caution is recommended when atropine is given to elderly patients because of the increased risk of side effects. The elderly appear to be more prone to the anticholinergic effects of atropine on the CNS, which can result in confusion, agitation, delirium, drowsiness, or coma.
Primary protection against exposure to chemical nerve agent and insecticide poisoning is the wearing of protective garments including masks, designed specifically for this use. Individuals should not reply solely upon the availability of antidotes such as atropine to provide complete protection from chemical nerve agent and insecticide poisoning.

Dialysis

Atropine is not significantly removed by hemodialysis.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Insecticide Poisoning

Insecticide Poisoning

Abstract

Approaches to suicide prevention

An intersectoral global public health initiative

Closing remarks

References

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Bradyarrhythmia

Usual Adult Dose for Anesthesia

Usual Adult Dose for Anticholinesterase Poisoning

Usual Adult Dose for Rhinorrhea

Usual Adult Dose for AV Heart Block

Usual Adult Dose for Head Injury

Usual Adult Dose for Peptic Ulcer

Usual Adult Dose for Organophosphate Poisoning

Usual Adult Dose for Nerve Agent Poisoning

Usual Adult Dose for Radiographic Exam

Usual Pediatric Dose for Anesthesia

Usual Pediatric Dose for Anticholinesterase Poisoning

Usual Pediatric Dose for Bradyarrhythmia

Usual Pediatric Dose for Rhinorrhea

Usual Pediatric Dose for AV Heart Block

Usual Pediatric Dose for Head Injury

Usual Pediatric Dose for Peptic Ulcer

Usual Pediatric Dose for Organophosphate Poisoning

Usual Pediatric Dose for Nerve Agent Poisoning

Renal Dose Adjustments

Liver Dose Adjustments

Precautions

Dialysis

Further information

More about atropine

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