The Exchange

Commentary and Observations from
the Medical Front Lines

Pesticide Poisoning: What APPs Should Know

Pesticide Poisoning: What APPs Should Know

Pesticides—which can be found in insecticides, herbicides, fungicides, rodenticides, molluscicides, and nematicides—can pose health risks to humans by impairing enzymes such as acetylcholinesterase and cytochrome c reductase, ion channels, and receptors. In animals, many of these pesticides have been linked to elevated rates of liver or kidney cancer.

From the 1940s through the 1960s, prior to extensive research on their adverse effects, organochlorine pesticides (ie, dichlorodiphenyltrichloroethane [DDT], lindane, mirex) were often used in agriculture and mosquito control. All are neurotoxicants; while many have since been banned in the US, a few are still used. Today, we are still constantly exposed to them, even in healthcare workplaces in the form of antimicrobial pesticides. Additionally, since the COVID-19 pandemic began, disinfectant use to control infection has surged, and pesticide exposure along with that use. As medical practitioners, we can play a significant role in preventing and minimizing the health issues that are associated with pesticide exposure.

Exposure to pesticides may occur via accidental inhalation (eg, following recent application to the landscape) or via ingestion of fish, dairy products, and other fatty foods that have been contaminated by groundwater or surface areas. Pesticide type; exposure amount, route, and duration; and the susceptibility of the exposed individual will dictate the level of health damage sustained. Many of the symptoms associated with pesticide poisoning are nonspecific; therefore, as providers we need to be sure to accurately obtain all possible information that may help assess the relevant risk of exposure. We must remember to take into consideration the patient's line of work or hobbies, as this can have a significant impact on exposure. As an example, exposure to organochlorine pesticides over a short period may produce convulsions, headache, dizziness, nausea, vomiting, confusion, muscle weakness, slurred speech, salivation, and sweating. Long-term exposure to organochlorine pesticides may damage the liver, kidney, central nervous system, thyroid, and bladder.

Recently, I was made aware of Pesticide Educational Resources Collaborative for Medical Professionals (PERC-med), an educational resource provided by a 5-year cooperative agreement between the Environmental Protection Agency's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University. Through various projects and initiatives, PERC-med has the overall goal of educating, training, and providing technical assistance to the public on the interplay of pesticides and human health. Included in these resources is a book aimed at enhancing clinical providers' knowledge of pesticide recognition and management. I think this is a great (and free) tool to aid clinicians by providing current consensus recommendations for assessing and treating patients with pesticide-related illnesses or injuries.

References

Filed under: Curbside Consultations, Miscellaneous

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