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Nascimento S, Göethel G, Gauer B, Sauer E, Nardi J, Cestonaro L, Correia D, Peruzzi C, Mota L, Machry RV, Furlanetto TW, Saint' Pierre T, Gioda A, Arbo MD, Garcia SC. Exposure to environment chemicals and its possible role in endocrine disruption of children from a rural area. ENVIRONMENTAL RESEARCH 2018; 167:488-498. [PMID: 30142624 DOI: 10.1016/j.envres.2018.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
Endocrine disrupting chemicals (EDCs), including pesticides and metals, are present in rural areas, endangering the health of exposed populations. This work aimed to investigate the possible association between the exposure to these xenobiotics and thyroid dysfunction in children living in a rural community of Southern Brazil. Fifty-four children aged 5-16 years participated in this study. Peripheral biomarker evaluations were performed in periods of low and high exposure to pesticides. Thyroid ultrasonography was evaluated in the high exposure period. Blood levels of chromium (Cr), manganese (Mn), mercury (Hg), and lead (Pb), as well as hair Pb levels were positively correlated with thyroid stimulating hormone (TSH) concentrations and negatively associated with free thyroxine (fT4) levels in the low exposure period. Prolactin was positively associated with hair Mn in both periods. In the ultrasound tests, the majority of children presented a normal echogenicity of thyroid. Glucose was inversely associated with the biomarker of exposure to cholinesterase inhibitor insecticides, butyrylcholinesterase (BuChE). Lipid profile was above the recommended levels in both periods. In summary, our results show that children environmentally exposed to a mixture of xenobiotics in an agricultural community may have health impairments, especially on thyroid function, dyslipidemia, and glucose homeostasis disruption.
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Affiliation(s)
- Sabrina Nascimento
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Gabriela Göethel
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Bruna Gauer
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Elisa Sauer
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Jessica Nardi
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Larissa Cestonaro
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Douglas Correia
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Caroline Peruzzi
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Luciano Mota
- Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Av. Roraima 1000, Santa Maria, RS, Brazil
| | - Rafael V Machry
- Departamento de Medicina Clínica, Universidade Federal de Santa Maria (UFSM), Av. Roraima 1000, Santa Maria, RS, Brazil
| | - Tania W Furlanetto
- Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos 2350, Porto Alegre, RS, Brazil
| | - Tatiana Saint' Pierre
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Marquês de São Vicente 225, Rio de Janeiro, RJ, Brazil
| | - Adriana Gioda
- Departamento de Química, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Marquês de São Vicente 225, Rio de Janeiro, RJ, Brazil
| | - Marcelo D Arbo
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil
| | - Solange C Garcia
- Laboratório de Toxicologia (LATOX), Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga 2752, Porto Alegre, RS, Brazil.
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Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med 2014; 18:735-45. [PMID: 25425841 PMCID: PMC4238091 DOI: 10.4103/0972-5229.144017] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms. However, several other manifestations are described. We review the spectrum of symptoms and signs in OP poisoning as well as the different approaches to clinical features in these patients. MATERIALS AND METHODS Articles were obtained by electronic search of PubMed(®) between 1966 and April 2014 using the search terms organophosphorus compounds or phosphoric acid esters AND poison or poisoning AND manifestations. RESULTS Of the 5026 articles on OP poisoning, 2584 articles pertained to human poisoning; 452 articles focusing on clinical manifestations in human OP poisoning were retrieved for detailed evaluation. In addition to the traditional approach of symptoms and signs of OP poisoning as peripheral (muscarinic, nicotinic) and central nervous system receptor stimulation, symptoms were alternatively approached using a time-based classification. In this, symptom onset was categorized as acute (within 24-h), delayed (24-h to 2-week) or late (beyond 2-week). Although most symptoms occur with minutes or hours following acute exposure, delayed onset symptoms occurring after a period of minimal or mild symptoms, may impact treatment and timing of the discharge following acute exposure. Symptoms and signs were also viewed as an organ specific as cardiovascular, respiratory or neurological manifestations. An organ specific approach enables focused management of individual organ dysfunction that may vary with different OP compounds. CONCLUSIONS Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.
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Affiliation(s)
- John Victor Peter
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Isiah Sudarsan
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - John L Moran
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
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Badrane N, Askour M, Berechid K, Abidi K, Dendane T, Zeggwagh AA. Severe oral and intravenous insecticide mixture poisoning with diabetic ketoacidosis: a case report. BMC Res Notes 2014; 7:485. [PMID: 25078103 PMCID: PMC4122673 DOI: 10.1186/1756-0500-7-485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background The widespread use of pesticides in public health protection and agricultural pest control has caused severe environmental pollution and health hazards, especially in developing countries, including cases of severe acute and chronic human poisoning. Diabetic ketoacidosis is an uncommon manifestation of acute pesticide poisoning. Suicidal pesticide poisoning by injection is also an unusual way to take poison. We report a severe pesticide mixture poisoning case with diabetic ketoacidosis in an adult with improved outcome after supportive treatment and large doses of atropine. Case presentation A 30-year-old unmarried Moroccan Arab male with a previous history of active polysubstance abuse and behavior disorders had ingested and self injected intravenously into his forearm an unknown amount of a mixture of chlorpyrifos and cypermethrin. He developed muscarinic and nicotinic symptoms with hypothermia, inflammation in the site of the pesticide injection without necrosis. Red blood cell cholinesterase and plasma cholinesterase were very low (<10%). By day 3, the patient developed stroke with hypotension (80/50 mmHg) and tachycardia (143 pulses /min). Laboratory tests showed severe hyperglycemia (4.49 g/dL), hypokaliemia (2.4 mEq/L), glycosuria, ketonuria and low bicarbonate levels (12 mEq/L) with improvement after intensive medical treatment and treatment by atropine. Conclusion Suicidal poisonings with self-injection of insecticide were rarely reported but could be associated with severe local and systemic complications. The oxidative stress caused by pyrethroids and organophosphates poisoning could explain the occurrence of hyperglycemia and ketoacidosis.
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Affiliation(s)
- Narjis Badrane
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Morocco.
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Liu SH, Lin JL, Shen HL, Chang CC, Huang WH, Weng CH, Hsu CW, Wang IK, Liang CC, Yen TH. Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus. Environ Health 2014; 13:11. [PMID: 24597539 PMCID: PMC3975839 DOI: 10.1186/1476-069x-13-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/28/2014] [Indexed: 05/12/2023]
Abstract
BACKGROUND We investigated the mortality rates of patients with and without diabetes mellitus after acute large-dose exposure to organophosphate insecticides. All patients without diabetes mellitus were traced to examine the long-term risk of new-onset diabetes mellitus. Previous reports indicated that organophosphate exposure might increase the risk of new-onset diabetes mellitus. METHODS We analyzed the records of 118 patients referred to Chang Gung Memorial Hospital for management of intentional organophosphate poisoning between 2000 and 2011. Patients were stratified by diabetes mellitus status. Demographic, clinical, laboratory and mortality data were analyzed. RESULTS Most patients were middle aged (53.45 ± 16.20 years) and male (65.3%) and were referred to our hospital after a relatively short amount of time had elapsed since poisoning (median 3.0 hours). 18 (15.2%) of 118 patients died, including 15 (13.8%) of 109 patients without diabetes mellitus and 3 (33.3%) of 9 with diabetes mellitus. There was no significant difference in mortality between these groups (P = 0.117). In a multivariate Cox regression model, hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and corrected QT interval prolongation (P = 0.002) were significant risk factors for mortality. Conversely, diabetes mellitus status was not a significant variable in this model. At routine outpatient follow up a median of 1.25 months post exposure, random blood glucose measurements gave no evidence of new-onset diabetes in patients without pre-existing diabetes. CONCLUSIONS Diabetes mellitus status might not increase mortality risk following acute large-dose exposure to organophosphates, and the risk of new-onset diabetes mellitus also might be minimal in the short term. Larger prospective studies with formal testing for diabetes at later times post-exposure are required.
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Affiliation(s)
- Shou-Hsuan Liu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Hsin-Lan Shen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chih-Chia Liang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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