PESTICIDES
ORGANOPHOSPHATES
N-METHYL CARBAMATES
PYRETHINS
PYRETHOIDS TYPE I
PYRETHOIDS TYPE II (CYANO-PYRETHOIDS)
ORGANOCHLORINES
CHLOROPHENOXY COMPOUNDS
DIPYRIDYL COMPOUNDS
ANTICOAGULANT RODENTICIDES
CHOLOROPHENOLS

NITROPHENOLS AND NITROCREOSOLS
METHYL BROMIDE FUMIGANTS
METAM SODIUM FUMIGANTS

PESTICIDES IMPLICATED IN CAUSING OR PROMOTING CANCER


ORGANOPHOSPHATES
CHEMICAL EXAMPLES
Chloropyrifos, diazinon, methyl parathion, malathion, azinphos-methyl, naled, glyphosate
PHYSIOLOGIC TARGET
Irreversibly inhibits acetylcholinesterase resulting in muscarinic and nicotinic effects
ACUTE SYMPTOMS
Vomiting, diarrhea, hypersecretion, confusion, bronchoconstriction, headache, dizziness, impaired vision, weakness, stomach cramps, cholinergic crisis, miosis, fatigue
DIAGNOSIS
Cholinesterase levels
TREATMENT
Supportive care, clear airway, improve tissue oxygenation, intravenous atropine, pralidoxime may be indicated, decontamination.


N-METHYL CARBAMATES
CHEMICAL EXAMPLES
Carbaryll, aldicarb, fenoxycarb, methomyl, bendiocarb.
PHYSIOLOGIC TARGET
Reversibly inhibits acetylcholinesterase resulting in muscarinic and nicotinic effects.
ACUTE SYMPTOMS
Malaise, muscle weakness, CNS depression, dizziness, nausea, vomiting, diarrhea, abdominal pain, blurred vision, hypersecretion, bronchoconstriction, headache.
DIAGNOSIS
Cholinesterase levels
TREATMENT
Supportive care, clear airway, improve tissue oxygenation, intravenous atropine, decontamination.


PYRETHRINS
CHEMICAL EXAMPLES
Pyrethrum
PHYSIOLOGIC TARGET
Neuronal paralysis, sensitization
ACUTE SYMPTOMS
Allergic reactions, anaphylaxis, tremor, ataxia at very high doses
DIAGNOSIS
No diagnostic test
TREATMENT
Decontamination, treat allergic reactions with antihistamines or steroids.


PYRETHROIDS TYPE I
CHEMICAL EXAMPLES
Allethrin, Permethrin, sumethrin, cyfluthrin, tetramethrin
PHYSIOLOGIC TARGET
Interference with sodium channel in neuronal cell membranes ­ repetitive neuronal discharge
ACUTE SYMPTOMS
Dizziness, irritability to sound or touch, headache, vomiting, diarrhea, blurred vision.
DIAGNOSIS
No diagnostic test
TREATMENT
Decontamination, supportive care, symptomatic treatment


PYRETHROIDS TYPE II (CYANO-PYRETHROIDS)
CHEMICAL EXAMPLES
Deltamethrin, cypermethrin, fenvalerate
PHYSIOLOGIC TARGET
Interferance with sodium channel and inhibition of gamma-aminobutyric acid (GABA)
ACUTE SYMPTOMS
Seizures, dizziness, irritability to sound or touch, headache, vomitiing, diarrhea, paresthesias
DIAGNOSIS
No laboratory test; skin contact may cause highly unpleasant temporary paresthesias
TREATMENT
Best treated with vitamin E oil preparations.


ORGANOCHLORINES
CHEMICAL EXAMPLES
Lindane, endosulfan, dicofol, methoxychlor
PHYSIOLOGIC TARGET
Blockade of chloride channel in the GABA receptor complex
ACUTE SYMPTOMS
Incoordination, tremores, paresthesia, hyperesthesia, headache, dizziness, nausea, hyperexcitable state, seizures
DIAGNOSIS
Detectable in blood and fat.
TREATMENT
Decontamination, supportive care, anticonvulsants, cholestyramine to clear enterohepatic recirculation, oxygen, cardiopulmonary monitoring.


CHLOROPHENOXY COMPOUNDS
CHEMICAL EXAMPLES
2,4-Dichlorophenoxyacetic acid (2,4-D), 2,4-DB, 2,4-DP
PHYSIOLOGIC TARGET
Peripheral neuropathy, myopathy, metabolic acidosis, skin and mucus membrane irritant, uncoupler of oxidative phosphorylation
ACUTE SYMPTOMS
Nausea and vomiting, diarrhea, headache, confusion, bizarre behavior, peculiar breath odor, myotonia, low fever, acidosis, EKG changes, CPK elevation, myoglobinuria
DIAGNOSIS
Detectable in urine and blood
TREATMENT
Decontamination, hydration, forced alkaline diuresis.


DIPYRIDYL COMPOUNDS
CHEMICAL EXAMPLES
Paraquat, diquat
PHYSIOLOGIC TARGET
Corrosive, free radical formation, lipid peroxidation, selective damages to pneumatocytes
ACUTE SYMPTOMS
Pain, diarrhea, headache, myalgias, acute tubular necrosis, delayed pulmonary edema; neurologic toxicity from diquat
DIAGNOSIS
Urine dithionite test (colorimetric), detectable in urine and blood
TREATMENT
Decontamination, do not administer oxygen unless patient develops severe hypoxemia, aggressive hydration, hemoperfusion.


ANTICOAGULANT RODENTICIDES
CHEMICAL EXAMPLES
Warfarin, brodifacoum, difenacoum, coumachlor, bromadiolone
PHYSIOLOGIC TARGET
Antagonize vitamin K, inhibition of clotting factors
ACUTE SYMPTOMS
Nosebleeds, bleeding gums, hematuria, melena, ecchymoses, anemia, fatigue, dyspnea
DIAGNOSIS
Elevated PT and INR
TREATMENT
Vitamin K1 (phytonadione), control seizures.


CHLOROPHENOLS
CHEMICAL EXAMPLES
Pentachlorophenol (PCP, Penta)
PHYSIOLOGIC TARGET
Uncouples oxidative phosphorylation, skin and mucus membrane irritant
ACUTE SYMPTOMS
Nose, throat and eye irritation, dermatitis, muscle spasm, abdominal pain, fever, tremor, thirst, sweating, tachycardia, hyperthermia, chest constriction, labored breathing, mental confusion
DIAGNOSIS
Detectable in blood and urine
TREATMENT
Decontamination, supportive care, control hyperthermia, cardiopulmonary monitoring.


NITROPHENOLS AND NITROCREOSOLS
CHEMICAL EXAMPLES
Dinocap
PHYSIOLOGIC TARGET
Uncouples oxidative phosphorylation; Affect hepatic, renal and nervous systems
ACUTE SYMPTOMS
Hyperthermia, tachycardia, tachypnea, anxiety, confusion, thirst, sweating, fever, headache, malaise
DIAGNOSIS
Detectable in serum, bright yellow staining of skin and urine.
TREATMENT
Supportive care, decontamination, control hyperthermia.


FUMIGANTS
CHEMICAL EXAMPLES
Methyl bromide
PHYSIOLOGIC TARGET
Irritant, inhibits sulfhydryl enzymes and reversibly breaks down ATP; CNS depressant
ACUTE SYMPTOMS
Headache, dizziness, nausea, ataxia, tremor, agitation, muscle weakness, visual disturbances, slurred speech, vomiting, seizures, respiratory distress, pulmonary edema, convulsions
DIAGNOSIS
Blood or urine bromide levels
TREATMENT
Supportive care, decontamination, benzodiazepines, dimercaprol, oxygen and diuresis for pulmonary edema.


FUMIGANTS
CHEMICAL EXAMPLES
Metam sodium
PHYSIOLOGIC TARGET
Decomposes in water to methyl isothiocyanate, severely irritant gas
ACUTE SYMPTOMS
Eye, lung and mucus membrane irritation, pulmonary edema
DIAGNOSIS
No diagnostic test
TREATMENT
Supportive care, decontamination.



PESTICIDES IMPLICATED AS CAUSING OR PROMOTING CANCER
HEMATOLOGIC
MALIGNANCIES IN ADULTS
 
Non-Hodgkins Lymphoma Phenoxy herbicides, dichlorophenoxyacetic acid (2,4-D), lindane (used for lice treatment), organophosphates, carbaryl, chlordane, DDT, diazinon, diclorvos, malathion, nicotine, toxaphene, and some fungicides.
Soft Tissue Sarcomas Phenoxy herbicides, chlorophenols with dioxin contaminants, and dioxins
CNS MALIGNANCIES IN ADULTS  
Brain Tumors No studies to implicate specific pesticides. However, occupational groups with pesticide exposure have an increased rate of brain tumors.
Lung Cancer Phenoxy herbicides, chlorophenols with dioxin contaminants, and dioxin.
Prostate Cancer No studies to connect specific pesticides; however, occupational exposure increases rate of prostate ca.
CHILDHOOD MALIGNANCIES  
Childhood Leukemia Parental and childhood residence in homes with home and garden pesticide use. Parents in presticide-using occupations during pregnancy.
Brain and Nervous System Tumors Home use of pesticides for flea and/or tick pet-treatments, pest strips, termite-control, lindane shampoo, yard and orchard pesticides, home pesticide bombs, and carbaryl for ouotdoor use during gestation and childhood, and occupation during pregnancy.

SOURCES
U.S. Environmental Protection Agency. Document # EPA 735-R-98-003
Recognition and Management of Pesticide Poisonings. Reigard and Roberts (1999)
Pesticides and Human Health: A Resoource for Health Care Professionals. Gina Solomon, 2000
Maryland Pesticide Network (www.mdpestnet.org)
Available online: http://www.epa.gov/oppfead1/safety/healthcare/handbook/handbook.htm