Approach to Pesticide Poisoning

Before discussing individual chemicals, a few principles of pesticide poisoning management should be addressed. The most important issue is proper diagnosis. Without it, all other interventions are potentially ineffective and possibly harmful.

Whenever possible, get the label of the suspected poison. It will contain principles of management and contact information for the manufacturer. The local poison control center and the National Pesticide Telecommunications Network (1-800-858-7378 Monday to Friday 9:30 a.m. to 7:30 p.m.) are also available for further advice. If coworkers have not been able to identify the suspect chemical, Cooperative Extension Service agents may also serve as a resource for commonly used chemicals at particular times of the year on specific crops.

Remember that careful decontamination of the patient is necessary to prevent possible further injury to the patient and possible injury to emergency department staff. Physical decontamination by removing clothing that has been in contact with the chemical, washing the skin with soap and water, and copiously irrigating the eyes is important. Recent evidence-based position statements from the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists suggest that gastric lavage, activated charcoal, cathartics, and ipecac should not be used routinely in poisoned patients. They can be considered within 60 minutes of presentation if a potentially life-threatening amount of poison has been ingested. Even in this circumstance, contraindications exist for the use of each: lavage is contraindicated in hydrocarbon ingestion; cathartic in volume depletion, hypotension, electrolyte imbalance, or ingestion of a corrosive substance; activated charcoal in an unprotected airway, a nonintact gastrointestinal (GI) tract or hydrocarbon ingestion; and ipecac in a nonalert patient or with ingestion of a hydrocarbon or corrosive substance (2).

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