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Pesticide poisonings in the lawn care and tree service industries. A review of cases in the New York State Pesticide Poisoning Registry.

Although pesticides are used extensively by lawn care and tree service workers, the incidence of pesticide poisonings among this population has never been systematically assessed. This article is a review of suspected and confirmed pesticide poisonings of lawn care and tree service applicators that were reported to the New York State Pesticide Poisoning Registry from 1990 to 1993. Thirty-nine cases were identified, of which 28 satisfied the criteria for a suspected or confirmed poisoning. At the time of the poisoning, the majority of applicators reported the use of more than one class of pesticide. The most common classes of pesticide applied were organophosphates (71%) and herbicides (43%). Twenty-four cases were identified through laboratory reporting. All 24 laboratory tests had been ordered for worker surveillance. Twenty of the reported workers were symptomatic. Personal protective equipment was used routinely by 22 of the 27 applicators for whom information was available. These data suggest that pesticide exposures are occurring among a subset of the lawn care and tree service applicators, despite the reported routine use of safety measures. More rigorous evaluation of the control measures utilized in the lawn care and tree and shrub industry is warranted.

Adult↗

Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes.

Organophosphate (OP) compounds have been used as pesticides and in chemical warfare (nerve agents). Two nerve agents, tabun and sarine, were used by the Iraqi army against Iranian troops and innocent people. Hundreds of the exposed combatants died in the field. Atropine sulphate has been used successfully in large doses to counteract the muscarinic effects of OP poisoning. The effects of oximes in human OP poisoning have not been well studied. Our aim was to study the effects of obidoxime and pralidoxime in OP pesticide poisoning. The patients were divided into three groups: atropine (A), obidoxime + atropine (OA) and pralidoxime + atropine (PA). Sixty-three patients (33 males, 30 females) with a mean age of 25 years were studied in different groups (43 A, 22 OA and 8 PA). There were no statistical significant differences in major clinical findings and acetylcholinesterase (AChE) activity on admission between the groups. Significant changes were observed during the treatment. Notwithstanding the severity of intoxication--particularly respiratory complications were more observed in the OA and PA groups--there were no fatalities in the PA group, whereas 4 (9%) and 6 (50%) patients in the A and OA groups died, respectively. AChE reactivation was only observed in the PA group, although it was not statistically significant (r = 0.4747). There was a good relationship between the AChE reactivation and outcome of the patients. High doses of obidoxime (8 mg/kg followed by 2 mg/kg/h) were found to be hepatotoxic and should be avoided. High doses of pralidoxime (30 mg/kg followed by 8 mg/kg/h) did not induce serious side effects and may be effective in some OP pesticides poisoning.

Adolescent↗

Erythroid karyorrhexis in the peripheral blood smear in severe arsenic poisoning: a comparison with lead poisoning.

Three men with severe arsenic poisoning were hospitalized with working diagnoses, respectively, of peptic ulcer, pancreatitis, and viral gastroenteritis. In the first two patients, correct diagnosis was delayed until the return of heavy-metal screening tests ordered because of painful peripheral neuropathy in one and sudden flaccid paralysis, resembling Guillain-Barré syndrome, in the other. Both patients had coarsely stippled red blood cells with markedly abnormal nuclei in their peripheral blood smears. These distinctive hematologic features led to an early diagnosis in the third patient. The author's review of past cases of lead poisoning showed that red blood cell karyorrhexis also tends to occur in patients who consume illicit whiskey ("moonshine"). Karyorrhexis or marked dyserythropoiesis in the peripheral smear, not heretofore described in arsenic or lead poisoning, may indeed be a unique hematologic clue. Scrutiny of the peripheral blood and/or buffy coat smear in patients with perplexing gastrointestinal or neurologic symptoms may enable earlier diagnosis and better therapy of arsenic poisoning.

Adult↗

Pesticide poisoning surveillance through regional poison control centers.

The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure to Minnesota residents, a mean age of 5 years (range, one month to 85 years) was identified; 50 percent of all cases were below age 3 years. Males accounted for 1.3 times as many cases as females. Insecticide was identified in the largest percentage of case files (74 percent) followed by herbicide (12 percent), rodenticide (11 percent) and fungicide-nonmedicinal (3 percent). Ingestion was the most common route of exposure; 85 percent of all calls originated from a residence. While insecticides are still the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event.

Adolescent↗

[Pesticide poisoning referred to the Poison Center of Milan in 1995-1998].

From 1995 through 1998 the Poison Control Centre of Milan identified 7594 cases of suspected or confirmed cases of acute pesticide poisoning. Domestic use products accounted for 4483 (59%) of the cases. Of these, 84% occurred at home and 48% in children under five. The most frequently reported domestic use products were pyrethrins/pyrethroids (26%), fertilizers (19%) and camphor/naphthalene (12%). Of 3111 cases (41%) due to agricultural products, 10% were children under five and 69% were males. Half of the poisonings from agricultural products occurred at home, the remainder at workplace. The products most frequently reported were organophosphates (26%), pyrethrins/pyrethroids (9%), and carbamates (9%). These preliminary data indicate the importance of implementing prevention programs to reduce pesticide poisonings with particular reference to young children.

Adolescent↗

[Consultations at the Poison Center of Rome on pesticide poisoning referrals].

From 1 January 1998 to 31 October 1999 the two Poison Control Centres active in Rome provided 923 telephone consultations for individuals and health care providers on suspected poisonings involving pesticides. Exposures more frequently reported in association with suspected cases were insecticides (n. 636), including organophosphates (n. 300), carbamates (n. 155), pyrethroids (n. 102), and organochlorines (n. 79). Children aged 1-4 years accounted for 22% of all suspected poisonings (n. 200). Each case was classified as to the likelihood of a relationship between the reported pesticide exposure and the occurrence of health effects. Around 18% of suspected pesticide poisonings (n. 168) were subsequently classified as definite, around 43% (n. 390) as possible, and around 37% were considered unlikely (n. 344).

Adolescent↗

[Lead poisoning in adults. Experience of the Poison Control Center of Marseille from 1993 to 2000].

OBJECTIVE: Report the experience of the Marseille's anti-poison center with lead poisoning adults. PATIENTS AND METHODS: Between 1993 and 2000, 45 adults patients consulted the poison Centre of Marseille for a history of lead exposure (9 women, 36 men, average age 44 YO, between 22 an 76 YO). The lead sources were mostly occupational (welding, heavy metal industries...), but some were environmental (shooting as a hobby, hunting,...). RESULTS: Ninety-one percent of the patients presented with a clinical feature of possible lead intoxication (asthenia, abdominal pain, anaemia, seizures,...). For 22 patients, calcitetracemate provocation test was negative. 6 patients with a positive test refused to be treated. 16 patients with a positive test were treated with chelation therapy (average lead blood level 566 micrograms/l--mini 320 micrograms/l, maxi 943 micrograms/l--and average lead urine elimination 3,011 micrograms/24 H--mini 789 micrograms/24 H, maxi 7,229 micrograms/24 H. 58 cures were done (1 to 12 cures for each patient). The average quantities of lead eliminated in the urine during the chelation therapy was 30,912 micrograms +/- 29,059 micrograms by case. For 12 patients who stopped the lead exposure after the diagnosis of lead poisoning, the chelaion therapy permitted to decrease the lead blood level of 69%. For 4 patients still exposed during the treatment, the lead blood level decrease of 7% only. For the 16 treated patiEnts, a clinical improvement was noted, and no adverse effects of chelation therapy was observed during the 58 cures.

Adult↗

[Cardiovascular drugs poisoning in the elderly patients hospitalized in the Province Poisoning Center in Lublin in the years 1995-2001].

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.

Aged↗

The Pittsburgh Poison Center profile of an American poison information center.

The Pittsburgh Poison Center (PPC), a department of Children's Hospital of Pittsburgh, was established in 1971 to provide emergency poison information to the residents of western Pennsylvania, especially the children. The PPC provides comprehensive poison information center services to the lay public and to medical professionals, poison prevention education, professional education and specialized services to the business and industry sector and governmental agencies.

Adolescent↗

[Profile of acute poisoning in Italy. Analysis of the data reported by Poison Centres].

Information relative to about 400 000 cases of human intoxications, registered by nine Italian Poison Centres between 1991 and 1998 is presented. Data have been collected and elaborated in the framework of an European project on improving the prevention and treatment of acute human poisoning (90/C 329/EEC Resolution). Sex, age group, etiological agent, place and circumstances of poisoning and risk estimation are the parameters analyzed for the characterization of this phenomenon. The following conclusions can be summarized from the overall picture. There is a slight prevalence of males over females (50.0% against 45.7%); 1-4 year age group presents the highest risk (37.0%), followed by 20-49 group (25.8%); drugs and household products are the prevalent causes of intoxications (37.4% and 26.0%, respectively); home is the place where 84.9% of accidents occur. Poisoning is accidental in 73.5% of the cases whilst suicides represent 18.7%. However, the outcome is positive in almost all cases and fatal accidents are not reported in the present casuistry.

Accidents↗

[Acute renal insufficiency caused by Amanita proxima poisoning: experience of the Poison Center of Marseille].

In southern France, some Amanita species are usually eaten like Amanita ovoidea (Quélet, 1872) which is a common white mushroom. In same areas, a similar and less common fungus can be encountered: Amanita proxima (Dumee, 1916). The first published cases of Amanita proxima poisonings with acute renal failure have been reported in 1994 by a medical team from Montpellier. A second article was published in 1995 by physicians from Marseille. In order to evaluate the importance of the confusion between the 2 species, we looked after these mushroom poisonings collected by the Poison Centre of Marseille. We found 31 cases concerning 53 patients. We observed the first intoxication in 1968. Poisonings took place in the south of Provence. Ingestions are in 26 cases (83% of the 31 cases) due to the confusion with Amanita ovoidea. The average delay between the meal and the first signs was 13 hours and 12 minutes. All patients had gastro-intestinal symptoms, and for 14 of them, oliguria or anuria appeared in a few days after ingestion. 11 patients needed temporary dialysis, and for 10 of them, moderate hepatic cytolysis was observed. The severity of symptoms seems to be dose-dependent: we collected cases in the same family with no signs after just tasting the meal, digestive symptoms only when patients at more, and renal failure for the hungry people.

Acute Kidney Injury↗

GLC analysis of poison ivy and poison oak urushiol components in vegetable oil preparations.

A procedure is described for the analysis of urushiol content of pharmaceutical preparations containing extracts of poison ivy (Toxicodendron radicans) and poison oak (T. diversilobum) in vegetable oils. The procedure involves extraction of the urushiols from the oily solutions using 90% methanol in water followed by GLC analysis of the extracts. Recoveries of both poison ivy and poison oak urushiols from solutions in corn oil, olive oil, sesame seed oil, and cottonseed oil were calculated. Correlation coefficients (r2) ranged from 0.97 to 1.00, and the coefficients of variations ranged from 3.08 to 7.90%.

Catechols↗

Clinical findings and follow-up evaluation of an outbreak of mushroom poisoning--survey of Amanita phalloides poisoning.

One hundred and sixty cases of mushroom poisoning during the period July-November 1981 are reported. The survey details 116 observations of short incubation syndromes and 44 cases of delayed syndrome, identified as Amanita Phalloides poisoning. Of the latter, 40 patients were adult (mean age 46 years, range 20-77; 18 females and 22 males) and 4 were children (less than or equal to 12 years old; 3 females and 1 male). All the patients with Amanita Phalloides poisoning were treated according to a therapeutic protocol, based on the infusion of high doses of penicillin G, administration of dexamethasone and thioctic acid, careful correction of water and electrolyte unbalance. The severity of the disease varied in the population of 44 patients: 4 patients died (2 females, 10 and 77 years old; 2 males, 56 and 64 years old); 26 patients were discharged from the hospital as clinically cured; 14 were discharged with persistently abnormal levels of transaminases and they were advised of a follow-up evaluation. The average length of stay in hospital was 2 weeks. Of the patients followed-up, 6 were symptom-free after 6 months, with normal transaminase values and a normal histopathological picture of liver biopsy specimens. In the remaining patients, there was no normalization of transaminase values and liver biopsy specimens showed a picture of chronic active hepatitis. These patients displayed abnormal immunological tests, with presence of immune complexes and of anti-smooth muscle autoantibodies. The results indicate that Amanita Phalloides poisoning represents a threat not only in the high mortality acute phase, but also in the development of chronic active hepatitis in some survivors.

Adolescent↗

Recurrent poisonings among paediatric poisoning victims.

A study of 1943 potentially toxic ingestions occurring in children under 6 years of age was conducted by 3 geographically and demographically diverse poison centres to determine the incidence of exposures to poison. Of the total group, 30.1% indicated that the child had experienced a prior poison exposure (12.0% in children under 1 year of age, and 41.3% of children between the ages of 3 and 5 years). Most repeaters (68.9%) experienced only 1 prior ingestion (range 1 to 15). Two prior ingestions were reported in 17.6% of repeaters; 3 prior ingestions in 4.4%. A profound effect of age on type of substance ingested was observed, with drugs accounting for 11.0% of ingestions in children under the age of 1 year, 23.2% in 1-year-old, and 49.9% in 2- to 5-year-old. A corresponding age-related decline in ingestions of household and personal care products was also noted. Although less marked than the age effect, a statistically significant propensity to re-ingest similar types of poisons was observed. Among repeaters, those with a prior ingestion of a drug subsequently ingested another drug 1.49 times more frequently than expected. A similar trend was observed with products (1.24 times more frequently) and plants (2.00 times more frequently).

Age Factors↗

A novel approach for heavy metal poisoning treatment, a model. Mercury poisoning by means of chelating microspheres: hemoperfusion and oral administration.

The chelating drugs BAL (2,3-dimercaptopropanol), EDTA (ethylenediaminetetraacetic acid), and penicillamine (2-amino-3-mercapto-3-methylbutanoic acid), which are used for metal poisoning, are toxic and there is a real need for alternatives, especially for severe cases. A novel approach for treatment of heavy-metal poisoning is under investigation in our group. The approach utilizes the synthesis of chelating microspheres specific for the desired metallic compound. The microspheres are suggested for use in severe cases by means of hemoperfusion, as a first aid, and then by oral administration. As a model this approach was tried for mercury poisoning. Polymercaptal microspheres of 0.8 micrometer average size were synthesized. The microspheres have a high surface area, have a high affinity toward organic and inorganic mercury compounds, and can compete easily with albumin and cysteine in the ability to bind mercury compounds. These microspheres also were encapsulated with agarose--a blood compatible polymer--and were tried successfully for plasma perfusion (in 10 min, 40% of CH3HgCl and of HgCl2 were removed from 20 ppm of poisoned plasma).

Administration, Oral↗

Poisoned food, poisoned uniforms, and anthrax: or, how guerillas die in war.

Many people believe that Rhodesia, struggling to maintain minority rule in Africa, used chemical and biological weapons against African guerilla armies in the liberation war. Clothes and food were routinely poisoned, and Rhodesian agents, perhaps in concert with global forces of reaction, caused the largest single outbreak of anthrax in modern times. Oral interviews with traditional healers and Rhodesians' confessional memoirs of the war suggest that deaths by poisoning or disease were not so straightforward, that guerillas and healers and doctors struggled to understand not only what caused death but also what kind of death a poisoned uniform or poisoned boot was.

Africa↗

The impact of nationally distributed guidelines on the management of paracetamol poisoning in accident and emergency departments. National Poison Information Service.

OBJECTIVE: To assess the impact of the treatment guidelines on the management of paracetamol self poisoning in accident and emergency (A&E) departments. METHODS: 24 A&E departments in Wales and England provided details of their management of paracetamol poisoning before and after the distribution of national treatment guidelines to all A&E departments in the United Kingdom. RESULTS: Significant increases were seen in the availability of formal written policies, the display of treatment nomograms, the recommendation to treat beyond 16 hours after ingestion, and to use a lower line on the treatment nomogram for patients at special risk of paracetamol induced liver damage. CONCLUSIONS: Regularly updated guidelines in the management of paracetamol poisoning should be displayed in A&E departments so that medical and nursing personnel have access to the best current information on the treatment of poisoning with this frequently used drug.

Acetaminophen↗

Childhood poisoning in Wales: experience of the Welsh National Poisons Unit (1984).

In 1984, 60% of all the enquiries made to the Welsh National Poisons Unit in Cardiff concerned children under 15, and 86% of the latter concerned children under 5. Nearly 60% of requests for information in childhood poisoning were about non-medicinal products and this contrasts with hospital admissions which are more often associated with medicinal products in this age group. Seasonal variability was noted for non-medicinal products such as pesticides and plant poisoning enquiries, whereas medicinal product enquiries remained constant over the year. The pesticides enquiries were greatest in Spring while those concerning plants were significantly greater in Summer. The latter was due to increased reports of ingestion of garden plants since the number of enquiries concerning house plants remained constant. Thus availability appears to be a major determinant of the risk of poisoning with any particular product in childhood.

Adolescent↗