Pesticide-Related Incidents Treated in Finnish Hospitals - A Review of Cases Registered Over a 5-Year Period

Profile of adult acute cholinesterase inhibitors substances poisoning - a 30 years analysis

Objectives

The objective of this study was to assess the pattern and outcome of acute cholinesterase inhibitors substances (CIS) poisoning cases, in a cohort from a regional tertiary care hospital.

Methods

cases admitted in the Toxicology Clinic of “Sf. Spiridon” Emergency Clinic Hospital Iasi, Romania between 1983 and 2013 were studied.

Results

a total number of 606 patients were included. The reason for exposures was intentional in 70% of cases and the commonest route of poisoning was oral in 92.2%. The highest percent of cases was females (56.4), the age group 20–29 (25.4%) and the majority (66.7%) coming from rural areas, 28.2% being agricultural workers. 36.6% of cases were severe clinical forms. Overall mortality rates were 3.8%, more than half of the death patients (65.2%) had concomitant alcohol intake. It was a significant statistical association between decrease level of serum cholinesterase on admittance and severe forms (p 0.000) and between survival and deaths groups (p 0.000). The pattern of poisoning described by our retrospective study suggests that CIS poisoning are mainly preventable. The main effective goals for prevention are restriction in free accessibility to toxic pesticides, together with sustained efforts in education concerning the life-threatening danger of pesticide poisoning.

Pesticide poisonings in South Korea: findings from the National Hospital Discharge Survey 2004-2006

OBJECTIVES

Pesticide poisoning stands as a major public health issue worldwide. The objective of this study was to examine the epidemiologic characteristics of pesticide-related hospitalizations in South Korea.

METHODS

Data from the Korea National Hospital Discharge Survey were analyzed to describe the epidemiologic characteristics of pesticide poisoning among hospitalized patients from 2004 through 2006. Pesticide-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision codes. National estimates of pesticide-related hospitalizations were calculated using sampling weights for number of hospitalizations.

RESULTS

A total of 25,982 pesticide-related hospitalizations were estimated during the years 2004-2006, yielding an average annual pesticide-related hospitalization rate of 17.8 per 100,000 population in South Korea. Age-specific rates for pesticide-related hospitalization increased with age, with the highest rate noted among those aged 70 or above. The majority of pesticide-related hospitalization was cases of intentional poisoning in rural areas. Seasonal variation in the rate was observed, with summer being the highest among both men and women.

CONCLUSIONS

Pesticide-related hospitalization is prevalent and demonstrates demographic and seasonal and regional variations. More effective strategies to reduce pesticide-related hospitalizations are required in South Korea.

California surveillance for pesticide-related illness and injury: coverage, bias, and limitations

The California Pesticide Illness Surveillance Program (PISP) is a major resource for pesticide illness epidemiology. This work attempts to improve characterization of pesticide illness in California, evaluate case ascertainment of the PISP and identify PISP's limitations and biases for studying the incidence and epidemiology of pesticide-related illness. Abstractors collected standardized information from 1994-1996 PISP files, poison control logs, hospital records, and death certificates. Linkage produced a merged file of all records that documented consideration of pesticide exposure as a cause of ill health. We identified 23 deaths and estimated 1,310 hospitalizations attributable to pesticide exposure, corresponding to 0.024 fatalities and 1.38 hospitalizations (95% confidence interval [CI] = 1.01-1.74) per 100,000 California population person-years. Most intoxications followed domestic exposures and were not reported to the surveillance program, which identified primarily occupational exposures. Excluding groups of five or more, we estimated 16% ascertainment (CI = 0.05-0.27) for non-agricultural occupational cases. Agricultural connections increased the probability of ascertainment to about 50%, cultural and economic barriers notwithstanding. Surveillance records existed for all identified episodes in which five or more people were exposed. California pesticide surveillance data appear complete for mass exposures, and adequate to characterize agricultural and occupational exposures. Work is needed to explore domestic exposures and occurrences beyond the reach of the health care system.

Mechanisms of toxicity, clinical features, and management of acute chlorophenoxy herbicide poisoning: a review

INTRODUCTION

Chlorophenoxy herbicides are used widely for the control of broad-leaved weeds. They exhibit a variety of mechanisms of toxicity including dose-dependent cell membrane damage, uncoupling of oxidative phosphorylation, and disruption of acetylcoenzyme A metabolism. Between January 1962 and January 1999, 66 cases of chlorophenoxy herbicide poisoning following ingestion were reported in the literature. FEATURES FOLLOWING INGESTION: Adjuvants in the formulations may have contributed to some of the features observed. Vomiting, abdominal pain, diarrhea, and, occasionally, gastrointestinal hemorrhage were early effects. When present, hypotension was predominantly due to intravascular volume loss, although vasodilation and direct myocardial toxicity may have contributed in some cases. Neurotoxic features included coma, hypertonia, hyperreflexia, ataxia, nystagmus, miosis, hallucinations, convulsions, fasciculation, and paralysis. Hypoventilation occurred not infrequently, usually in association with central nervous system depression, but respiratory muscle weakness was a factor in the development of respiratory failure in some patients. Myopathic symptoms including limb muscle weakness, loss of tendon reflexes, and myotonia were observed and increased creatine kinase activity was noted in some cases. Other clinical features reported included metabolic acidosis, rhabdomyolysis, renal failure, increased aminotransferase activities, pyrexia, and hyperventilation. Twenty-two of 66 patients died. FEATURES FOLLOWING DERMAL AND INHALATIONAL EXPOSURE: Substantial dermal or inhalational 2,4-dichlorophenoxyacetic acid exposure has occasionally led to systemic features but no such reports have been published in the last 20 years and no fatalities have been reported at any time. Substantial dermal exposure has been reported to cause mild gastrointestinal irritation after a latent period followed by progressive mixed sensory-motor peripheral neuropathy. Mild, transient gastrointestinal and peripheral neuromuscular symptoms have also occurred after occupational inhalation exposure, with or without dermal exposure.

MANAGEMENT

In addition to supportive care, alkaline diuresis to enhance herbicide elimination should be considered in all seriously poisoned patients. Limited clinical data suggest that hemodialysis produces similar herbicide clearance to alkaline diuresis without the need for urine pH manipulation and the administration of substantial amounts of intravenous fluid in an already compromised patient.

CONCLUSIONS

While chlorophenoxy herbicide poisoning is uncommon, ingestion of a chlorophenoxy herbicide can result in serious and sometimes fatal sequelae. In severe cases of poisoning, alkaline diuresis or hemodialysis to increase herbicide elimination should be considered.

Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States

STUDY OBJECTIVE

To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States.

METHODS

Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990.

RESULTS

There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%).

CONCLUSION

Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature.

Massive ingestion of the herbicide 2-methyl-4-chlorophenoxyacetic acid (MCPA)

OBJECTIVE

To report the course of a massive ingestion of the herbicide 2-methyl-4-chlorophenoxyacetic acid or MCPA (4-chloro-2-methyl phenoxy acetic acid) and to correlate plasma 2-methyl-4-chlorophenoxyacetic acid levels with symptoms of intoxication and treatment.

CASE REPORT

After intentional ingestion of the herbicide, 2-methyl-4-chlorophenoxyacetic acid, a young man suffered burning in his mouth, spasmodic pain in the extremities and a severe hypotensive crisis. Plasma 2-methyl-4-chlorophenoxyacetic acid concentration was 546 mg/L two hours after ingestion. Therapy by forced diuresis was ineffective until the urine was alkalinized (Day 4). This resulted in a rapid decline of the plasma 2-methyl-4-chlorophenoxyacetic acid level to 6 mg/L and recovery of the patient.

Swedish pesticide risk reduction 1981-1995: food residues, health hazard, and reported poisonings

The Swedish Government has initiated three pesticide risk-reduction programs since the mid-1980s. Risk-reduction achievements have been measured mainly in terms of reduction in quantities sold. In this review, risk-reduction achievements have been described also in terms of pesticide residues in foods, both imported and grown domestically, acute health hazard to the users, and reported poisonings. The time periods selected for comparisons are 1981-1985 (which is the Government's baseline period), 1990-1994 for food residues and poisonings, and 1991-1995 for acute health hazard and quantities sold. The quantity of pesticides as active ingredient (ai) sold for use in agriculture, horticulture, and forestry decreased from a total of 22,800 tons during 1981-1985 to 8450 tons in 1991-1995, a 63% reduction. Published data on pesticide residues in domestically grown fruits and vegetables show that the proportion of cases of reported residues higher than 20% of the maximum residue limit has decreased only slightly, from 6.9% to 6.2%. Residues in imported food crops of the same type increased from 31% to 37%. Overall, the achieved 63% reduction of quantities used may have resulted in only a 10% reduction in number of cases of reported residues. A forthcoming report on pesticide intake via food from the National Food Administration may shed light on any trends in actual residue levels. The degree of goal fulfillment for the pesticide residue monitoring program and for pesticide residue levels in food is difficult to judge because of imprecise goal formulations. An estimate of the potential acute health hazard to the pesticide users, based on quantities and acute toxicity of individual pesticides, indicates that the acute health hazard in terms of "acute toxicity equivalents" decreased by 71%. The number of poisonings caused by acute exposure at the workplace has decreased between 1984 and 1994, whereas the number of mostly harmless incidents at home has increased. The decline in workplace-related accidents and the favorable pattern and low frequency of pesticide poisonings in Sweden compared to many other countries, especially developing countries, is the result of several factors, such as the mandatory training of workers using pesticides professionally, severe restrictions in availability of pesticides for use in households, and withdrawal from the market of the most toxic pesticides. To improve the worrisome global situation, it would seem appropriate that the United Nations Food and Agriculture Organization pay greater attention to the need for promotion of restrictions on availability of highly toxic and other pesticides, as recommended by FAO and WHO in 1975 (WHO/FAO 1975).

Pesticide incidents reported to the Health and Safety Executive 1989/90- 1991/92

1. Data concerning pesticide incidents investigated by the Field Operations Division (FOD) of the Health and Safety Executive (HSE) in Great Britain have been collated for the three year period April 1989 to March 1992. Over this period the HSE investigated 613 incidents concerning pesticides: 338 related to general or environmental complaints not involving human poisoning and 275 were suspected poisoning incidents. 2. The two hundred and seventy-five suspected poisoning incidents were assessed by the Pesticide Incidents Appraisal Panel (PIAP) as 'confirmed', 'likely', 'unlikely', 'not confirmed', or that there were 'insufficient data' to make an assessment. Assessed data are unavailable for eight incidents reported in 1989. 3. Four hundred and eighteen members of the public were involved in 202 assessed incidents and 79 workers were exposed in 65 assessed incidents. Overall, 129 (48%) incidents were assessed as 'confirmed' or 'likely', 121 (45%) as 'unlikely' or 'not confirmed' and in 17 (6%) there were 'insufficient data' to form a judgement. Incidents occurring in an occupational setting were assessed as 'confirmed' or 'likely' more frequently (62%) than those involving members of the public (44%). 5. Thirty-six per cent of those involved in a 'confirmed' poisoning incident were working with a pesticide or were in close proximity to the operator; 41% were on private property adjacent to a field being sprayed and a further 23% involved those walking, cycling or jogging past a sprayed field.(ABSTRACT TRUNCATED AT 250 WORDS)

Deaths from pesticide poisoning in England and Wales 1990-1991

1. Data on deaths from pesticide poisoning occurring in England and Wales in 1990 and 1991 have been collated. Pesticides were responsible for 44 of 3978 deaths from poisoning (excluding carbon monoxide and other gases) over this period. 2. At least 66% of all pesticide fatalities were due to suicide and overall there was a predominance of males (male:female ratio 2.4:1). Eighty per cent of deaths occurred in those more than 44 years old and no child under 10 years old died, although almost 50% of suspected pesticide poisoning incidents involve this age group. 3. Herbicides were responsible for 35 of the 44 deaths; seven were caused by insecticides, one by a molluscicide and one by an unspecified agent. The herbicide, paraquat, was responsible for 33 of 44 deaths (75%) and, although fewer fatalities have occurred from this cause in recent years, paraquat remains the most common cause of fatal pesticide poisoning in England and Wales.

Suspected paediatric pesticide poisoning in the UK. I--Home Accident Surveillance System 1982-1988

1. Between 1982 and 1988, 239,350 children under 10 years old attended 20 A & E Departments in England and Wales (22 departments throughout the UK in 1988) as a result of a home accident. 15,144 of 239,350 were suspected cases of poisoning and 514 attendances involved pesticides. 2. 501 of 514 children who attended hospital were under 6 years old and 41% were thought to have ingested a rodenticide, 37% an insecticide or other animal poison, 13% an herbicide or fungicide and 9% other pesticides. 3. Overall 189 of 514 children were admitted to hospital and of these 189 cases 35% were discharged home in less than one day; 94% left hospital within 2 days. 4. Using these data we estimate that over the period of study approximately 1,850 children annually attended an Accident and Emergency Department in the UK with suspected pesticide poisoning and that some 450 were admitted to hospital. However, the morbidity from this cause is low and no deaths from pesticide poisoning have been reported in children in England and Wales for more than two decades.

Deaths from pesticide poisoning in England and Wales: 1945-1989

1. Data on deaths from pesticide poisoning occurring in England and Wales between 1945 and 1989 (no data are available for 1954) have been collated; pesticides were responsible for only 1012 (1.1%) of the 87,385 deaths from poisoning (excluding those due to carbon monoxide) occurring over this 44 year period. At least 73% of all pesticide fatalities were due to suicide and overall there was a predominance of males (male:female ratio 2.4:1). No deaths from pesticide poisoning in children under 10 years have been reported since 1974 although almost 50% of suspected pesticide poisoning incidents involve this age group. 2. Herbicides were responsible for 787 (78%) fatal poisonings, 110 (11%) were caused by insecticides, 69 (6.8%) by rodenticides, 30 (3.0%) by wood preservatives and 16 (1.6%) by other pesticides. 3. The herbicide, paraquat, was responsible for 570 of 1012 (56%) deaths and, although there has been a progressive decline in the annual number of deaths from paraquat poisoning since 1982, paraquat remains the most common cause of fatal pesticide poisoning in England and Wales. 4. Sodium chlorate caused 113 (11.2%) deaths, most of these fatalities occurring between 1965 and 1983; only one death has been recorded since 1984. The phenoxyacetate herbicides resulted in 50 deaths; 2,4-D was implicated most commonly. Sixty-eight deaths were due to organophosphorus insecticides; demeton-S-methyl, malathion and mevinphos were involved most frequently. Only eight deaths resulted from organochlorine insecticides and two of these also involved an organophosphorus insecticide.(ABSTRACT TRUNCATED AT 250 WORDS)