Diagnosis and Treatment of Poisoning Due to Pesticides

This chapter covers diagnosis and management of both acute and chronic pesticide poisoning, which presents a significant challenge to current clinical capabilities. There are increasing attempts to carry out prospective clinical studies to answer clinically significant challenges to improve the outcome of patients poisoned by pesticides. Pesticides may be categorized by major agricultural classes of insecticides, herbicides, and fungicides. Additional groupings are rodenticides, nematocides, molluscides, acaricides, larvacides, miticides, pediculicides, scabicides, attractants (pheromones), defoliants, desiccants, plant growth regulators, and repellants. Greater risk rates of pesticide poisonings may be expected in countries with fewer regulatory controls where pesticides may be used extensively. Organophosphates and N-methyl carbamates are the pesticides that most commonly cause systemic illness. Acute severe organophosphate poisoning is one of the most life-threatening human poisonings, but it is also treatable (atropine plus pralidoxime), often with a good outcome if treatment is begun promptly and early in the time course of poisoning. With careful attention to the details of exposure history and clinical findings in each individual patient, coupled with knowledge of the specific pesticide involved, an individualized management plan can be formulated that should be beneficial for most patients.