Pesticides & Insecticides

Khurram Raja

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Poisoning cases from January 1st 2003 to May 15th 2004 Age & Sex Distribution
Poisoning cases from January 2003 to May 2004
Type Allied hospital DHQ hospital
y Age group Cases Sex Cases
Rat killers 134 31 10-20 years 655
Sedatives 278 101
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21-30 years 523 Males 1247
Wheat Pills 638 151
31-40 years 199
Acid ingestion 55 05
41-50 years 35 Females 331
Inebrients 107 61
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(Robbery) 51-60 years 99

CuSO4 - 17 61-70 years 33 Total 1578
Total 1578
Total 1212 366
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Deaths in Poisoning Cases

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From January 1st 2003 to May 15th 2004

Cases
Organophosphorus
50.0% Deaths
13.2% Poisoning

Unknown fate
16.2%
LAMA/DOR Recovered
11.9% 8.7%
Records

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 Ancient Awareness
History records many examples of
plagues and efforts to control them
1000 BC China Sulfur used as a fumigant
to kill bacteria and fungus
Sulfur is widely used to day, e.g.
protecting wine barrels and in wine.
History of Nerve Agents
n Earliest recorded use is by native
tribesmen of Africa who used Calabar
bean as agent inhibiting cholinesterase.
n In 1864, its active principle was isolated
known as Physostigmine (Eserine).
n First organophosphorus ChE inhibitor
was Tetraethyl Pyrophosphate (TEPP).

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History of Nerve Agents History of Nerve Agents
n In 1930s, interest in both physostigmine
y n Five Organophosphorus compounds are
regarded as Nerve agents:
ud
(reversible) & organophosphorus
Tabun (GA)
(irreversible) ChE inhibitors increased. Sarin (GB)
n Reversible ---- used for intestinal atony, Soman (GD)
mysthenia gravis & glaucoma. GF
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VX
n In 1936, Gerhard Schrader synthesized tabun
& then sarin & handed over to German
Defence Ministry
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History of Nerve Agents

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n Soviet Union USA & UK

n The United States began to produce
sarin in the early 1950s, and VX in
early 1960s, for potential military use
n During the Persian Gulf War (1990-
1991), Iraq believed to have GB & GF
n Sarin has also been used in terrorist
attacks

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 Pesticides
n Poison gas research in Germany
yielded the organophosphorus
compounds, the best known of which is
parathion.
n Further research yielded hundreds of
organophosphorus compounds, the
most noteworthy being malathion.
Pesticides
n Today, some 900 active chemical pesticides
are used to manufacture 40,000 commercial
preparations.
n The Environmental Protection Agency (EPA)
estimates that the use of pesticides doubled
between 1960 and 1980.
n Currently, over 372 million kilograms a year
are used in the United States, with over 1.8
billion kilograms a year used worldwide.

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Definition - Simple Definition - EPA

The function of a pesticide is to kill

y a pesticide is any substance or mixture of
substances intended for preventing, destroying,
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repelling, or mitigating any pest.
or harm some form of life.
a pest is any harmful, destructive, or troublesome
animal, plant or microorganism.
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US Environmental Protection Agency (EPA)

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Classes Of Pesticides
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Insecticides
Insecticides (kill insects)
Organochlorines
Organophosphates Insecticides (kill insects)
Carbamates
Organochlorines
Synthetic Pyrethroids
Organophosphates
Herbicides (kill plants)
Carbamates
Rodenticides (kill rodents) Synthetic Pyrethroids
Fungicides (kill fungus)
Fumigants (kill whatever)

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 Chlordane What Is This?

Chlordane Americas leading lawn and garden H

insecticide. Used extensively by pest control
operators for termite control, because of its Cl C Cl
long lasting effectiveness.
CCl3

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DDT Rodenticides (kill rodents)
H y Botanicals
Red squill effects heart
Strychnine blocks glycine receptors in
Cl C Cl
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spinal cord - convulsions

CCl3 Inorganics
Phosphorous GI track
Organochlorine insecticide Thallium hair loss, nervous system
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1945 control of mosquitoes Zinc phosphide GI track

Effective but very persistent Anticoagulants
Very soluble in fat Warfarin inhibits blood clotting
Damaged bird eggs Vacor newer blood clot inhibitors
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Fungicides (kill fungi/mold) Routes of Absorption

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n Inhalation
n Ingestion
Early Examples n Dermal absorption
Sulfur, copper sulfate
Mercury based compounds Mechanism of Action
Hexachlorobenzene
n Inhibition
of Acetylcholinesterase in
Pentachlorophenol nervous system resulting in respiratory,
Dithiocarbamates myocardial & neuro muscular
transmission impairment

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 Mechanism of Action
Home Exposure
Oganochlorines & Pyrethroids
- Enzymes, axonal membranes
(Na+, K+, Ca++, Cl-)
Accidental ingestion
Organophosphates & Lawn and garden use
Carbamates
- excess acetylcholine
Insect control
Food supply
Water supply

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Occupational Exposure Other Exposure
Farms & Farm worker y Dietary exposure
Pesticide applicator
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Pesticide residues on crops
Manufacture Community exposure
Mixing and handling Airborne drift from commercial app
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Landscapers Contaminated drinking water

Many more Leaching from soils to ground water
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Target Organs Clinical Effects

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n Nervous system n Effects caused by excess acetylcholine

n Respiratory system (cholinergic syndrome)
n Cardiovascular system n 3 groups
Muscarinic effect (Parasympathetic overactivity)
Nicotinic effect (Sympathetic overactivity)
Central nervous system effect

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 Mild Symptoms Moderate Symptoms
Anorexia Headache
Nausea Salivation
Dizziness Weakness
Bronchorrhoea Lacrimation
Anxiety Sub sternal discomfort
Abdominal cramps Diarrhea
Fasciculations of Miosis
Vomiting Sweating
tongue & eyelids
Impairment of visual Lethargy Hypertension Muscular fasciculations
acuity

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Severe Symptoms Nicotinic Effects
y n Skeletal muscle weakness & paralysis
Miosis or mydriasis Non-reactive pupils
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Dyspnoea Respiratory depression Muscrinic Effects
Pulmonary oedema Cyanosis n Bronchospasm
Loss of sphincter Convulsions n Bronchorrhoea
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control
n Aspiration
Coma Bradycardia
n Bradyarthmias
Cardiac ischemia Hypokelimia
n Hypotension
Acute pancreatitis Muscular paralysis
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Diagnosis Laboratory Analysis

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n In the absence of history, it is initially, n Complete blood cell count

clinical. n Serum electrolyte levels
n Foul smell (garlic like) in breath.
n Arterial PH & blood gases
n Clothes contaminated with faeces,
n Liver function tests
vomiting.
n Favorable response to Atropine is more n ECG & Chest X-Rays
useful diagnostic sign. n Cholinesterase levels
n Cholinesterase assay.

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 Serum Cholinesterase Differential diagnosis
n Normal value 4500-10500 IU n Nicotine poisoning
n Pt.become symptomatic when n Drugs
concentration is below 70% n Pontine Hemorrhage
n Gastroenteritis
n Asthma
n Guillain-Barre syndrome

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First Aid Measures & Management First Aid Measures & Management

n Chemical
possible
be removed as quickly as
y n In acute respiratory failure, keep airway
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open & prevent aspiration.
n Atropine to be administered n Oxygen to be given.
n Contaminated clothing to be removed
n In case of ingestion, Lavage should be
n In skin contact, area to be washed by by
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done within 1 hour of ingestion.

soap & water.
n Activated charcoal maybe helpful.
n First-aid personnel should wear rubber
or plastic gloves
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Atropine Atropine
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n Atropine administered I/V in doses of 1- n In very severe cases bolus injections of

2 mg (0.5 mg/kg) every 5 to 10 minutes more than 10 mg may be necessary
until signs of atropinisation,
n Atropine must be continued to maintain
Dilated & fixed pupils
atropinisation until patient recovers
Loss of salivation (dry mouth)
Bronchial hypersecretion
or complete reversal of symptoms
occurs

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 Contrathion (Paralidoxime)
n Itis most effective if administered
immediately or within 24 hours
n Adult Dose:
1-2 gms in infusion of 100 ml saline over 15-20
minutes. Injection speed should not exceed 200
mg/min
After one hour second dose is required
Maximum dose of 12 gms in 24 hours has been
suggested
In children, 20-60 mg/kg body weight is suggested
Diazepam
n5 to 10 mg (0.2 to 0.3 mg/kg) by slow
I/V over 3 minutes, maybe repeated
every 10 to 15 min (maximum 30 mg) to
control convulsions
n Physiotherapy maybe needed for
delayed peripheral neuropathy

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Post mortem findings Complications
n Externally, cyanosis is present
y n Intermediate syndrome (IMS)
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n Internally, n Begin 24-96 Hrs. after the poisoning
Garlic like or kerosine like smell from and after the resolution of a cholinergic
stomach phase. Last for 5-32 days.
Pulmonary oedema n Consist of paralysis of proximal limb
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Petechial haemorrhages muscles, neck flexor muscles,

n Organo phosphorus can be detected in respiratory muscles and various motor
highly decomposed bodies cranial nerve.
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Complications Medico legal Importance

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n Delayed peripheral Neuropathy n Accidental poisoning of children

1-5 weeks after exposure
n Occupational exposure among adult
n
n Neuropathy typically begins with paresthesias and
pain followed by ataxia weakness and toe drop. farm workers and secondary accidental
n It rapidly progress to a flaccid pracsis (cf. Guillain- exposure to their families can occur
n Suicide attempts probably account for
Barre syndrome)
n May progress for 2-3 months and muscle wasting
occurs. more severe and more frequent
n Recovery of motor functions occurs in reverse order poisonings
in which the functions were lost.

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 Medico legal Importance
n Exposure of the general population
through the consumption of foodstuffs
treated incorrectly with pesticides or
harvested prematurely
n Accidental poisonings can also occur
through failure to observe the safe re-
entry time after application.
Medico legal Importance
n Occupationally exposed populations
Factory workers involved in synthesizing
pesticides.
Workers involved in formulating and dispensing
pesticides.
Agricultural spray workers.
Crop harvesters during disease vector control
periods.
Public-health workers involved in vector control.
Health workers not following the correct
procedures when handling poisoned patients,

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Environmental Risks Summary
n3 routes of entry in water resources
y Reduce use
Reduce Exposure
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Industrial waste or affluent
Seepage from buried toxic wastes into
water supplies Seek alternatives
Contamination of running water directly Integrated Pest Management (IPM)
Beware of local and global
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n Carcinogenic
n Teratogenic use
n Mutagenic
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