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Wu YJ, Chang SS, Chen HY, Tsai KF, Lee WC, Wang IK, Lee CH, Chen CY, Liu SH, Weng CH, Huang WH, Hsu CW, Yen TH. Human Poisoning with Chlorpyrifos and Cypermethrin Pesticide Mixture: Assessment of Clinical Outcome of Cases Admitted in a Tertiary Care Hospital in Taiwan. Int J Gen Med 2023; 16:4795-4804. [PMID: 37908758 PMCID: PMC10614644 DOI: 10.2147/ijgm.s432861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Background and Purpose There is an overall paucity of data regarding the human toxicity of chlorpyrifos and cypermethrin pesticide mixture. Both organophosphate and pyrethroid insecticides are metabolized by carboxylesterases. Thus, its pesticide combination, organophosphates may boost the toxicity of pyrethroids via inhibited its detoxification by carboxylesterases. This study examined the clinical course, laboratory tests, and outcomes of patients with chlorpyrifos, cypermethrin or their pesticide mixture poisoning, and to determine what association, if any, might exist between these findings. Patients and Methods Between 2000 and 2021, 121 patients poisoned with chlorpyrifos, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. Patients were categorized as chlorpyrifos (n=82), cypermethrin (n=27) or chlorpyrifos and cypermethrin (n=12) groups. Demographic, clinical, laboratory and mortality data were collected for analysis. Results The patients experienced a broad range of clinical symptoms, including aspiration pneumonia (44.6%), salivation (42.5%), acute respiratory failure (41.3%), acute kidney injury (13.9%), seizures (7.5%), hypotension (2.6%), etc. Leukocytosis (12,700±6600 /uL) and elevated serum C-reactive protein level (36.8±50.4 mg/L) were common. The acute respiratory failure rate was 41.3%, comprising 48.8% in chlorpyrifos, 11.1% in cypermethrin as well as 58.3% in chlorpyrifos and cypermethrin poisoning. Patients with chlorpyrifos and cypermethrin pesticide mixture poisoning suffered higher rates of acute respiratory failure (P=0.001) and salivation (P=0.001), but lower Glasgow Coma Scale score (P=0.011) and serum cholinesterase level (P<0.001) than other groups. A total of 17 (14.0%) patients expired. The mortality rate was 14.0%, including 17.1% in chlorpyrifos, 3.7% in cypermethrin as well as 16.7% in chlorpyrifos and cypermethrin poisoning. No significant differences in mortality rate were noted (P=0.214). Conclusion Chlorpyrifos pesticide accounted for the major toxicity of the pesticide mixture. While the data show a higher rate of respiratory failure in the chlorpyrifos and cypermethrin pesticide mixture group than others, other measures of toxicity such as mortality and length of stay were not increased.
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Affiliation(s)
- Yi-Jan Wu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Kai-Fan Tsai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung City, Taiwan
| | - Wen-Chin Lee
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung City, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chern-Horng Lee
- Division of General Internal Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Uys F, O'Neill M, Farina Z, Belford J. Case Report. S Afr Med J 2023; 113:57-60. [PMID: 36757073 DOI: 10.7196/samj.2023.v113i2.16832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
The illegal practice of combining organophosphates (OPs) with other compounds such as carbamates and pyrethroids, creating 'streetpesticides', is common in South Africa. These agents contain mostly unknown quantities of unregulated toxins and contribute to atypicaland unpredictable clinical presentations following human ingestion. We present such a case in a patient with intentional rodenticideingestion. The initial presentation in the emergency department was a classic cholinergic toxidrome, and clinical resolution was achievedafter provision of atropine. This was followed 12 hours later by an acute decompensation resulting from an apparent sympatheticallydriven episode of autonomic instability and acute pulmonary oedema requiring immediate respiratory and haemodynamic support. In ourdiscussion, we explore this secondary decompensation and suggest various pathophysiological explanations for this atypical clinical coursefollowing what had appeared to be OP poisoning. The patient was discharged home after a total of 6 days in hospital.
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Affiliation(s)
- F Uys
- Department of Anaesthesia and Critical Care, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa.
| | - M O'Neill
- Department of Anaesthesia and Critical Care, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa.
| | - Z Farina
- Head, Clinical Department: Anaesthesia and Critical Care, Greys Hospital, Pietermaritzburg, South Africa; Honorary lecturer, Department of Anaesthesia and Critical Care, University of KwaZulu-Natal, Pietermarizburg, South Africa.
| | - J Belford
- Department of Anaesthesia and Critical Care, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa.
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Zoofaghari S, Namakizadeh Esfahani N, Akhavan Sigari A, Tavakoli N, Hashemzadeh M, Eizadi‐Mood N. Uncommon manifestation of poisoning with a mixture of pesticides. Clin Case Rep 2022; 10:e05365. [PMID: 35154719 PMCID: PMC8819642 DOI: 10.1002/ccr3.5365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/02/2021] [Accepted: 09/24/2021] [Indexed: 11/09/2022] Open
Abstract
The ingestion of pesticides for suicide commitment purposes is common in developing countries. We present a case of suicide with ingestion of mixed pesticides. The autopsy findings showed the presence of diazinon, chlorpyrifos, trifluralin, fenpropathrin, pyriproxyfen, and cypermethrin in his body. Clinicians managing poisoning cases need to be aware of poisoning with mixture of pesticides as a rare but highly fatal outcome.
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Affiliation(s)
- Shafeajafar Zoofaghari
- Isfahan Clinical Toxicology Research CenterDepartment of Clinical ToxicologyIsfahan University of Medical SciencesIsfahanIran
| | | | | | - Nasim Tavakoli
- Isfahan Clinical Toxicology Research CenterDepartment of Clinical ToxicologyIsfahan University of Medical SciencesIsfahanIran
| | - Mozhdeh Hashemzadeh
- Clinical Informationist Research GroupHealth Information Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Nastaran Eizadi‐Mood
- Isfahan Clinical Toxicology Research CenterDepartment of Clinical ToxicologyIsfahan University of Medical SciencesIsfahanIran
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El-Nahhal Y, El-Nahhal I. Cardiotoxicity of some pesticides and their amelioration. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:44726-44754. [PMID: 34231153 DOI: 10.1007/s11356-021-14999-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Pesticides are used to control pests that harm plants, animals, and humans. Their application results in the contamination of the food and water systems. Pesticides may cause harm to the human body via occupational exposure or the ingestion of contaminated food and water. Once a pesticide enters the human body, it may create health consequences such as cardiotoxicity. There is not enough information about pesticides that cause cardiotoxicity in the literature. Currently, there are few reports that summarized the cardiotoxicity due to some pesticide groups. This necessitates reviewing the current literature regarding pesticides and cardiotoxicity and to summarize them in a concrete review. The objectives of this review article were to summarize the advances in research related to pesticides and cardiotoxicity, to classify pesticides into certain groups according to cardiotoxicity, to discuss the possible mechanisms of cardiotoxicity, and to present the agents that ameliorate cardiotoxicity. Approximately 60 pesticides were involved in cardiotoxicity: 30, 13, and 17 were insecticides, herbicides, and fungicides, respectively. The interesting outcome of this study is that 30 and 13 pesticides from toxicity classes II and III, respectively, are involved in cardiotoxicity. The use of standard antidotes for pesticide poisoning shows health consequences among users. Alternative safe medical management is the use of cardiotoxicity-ameliorating agents. This review identifies 24 ameliorating agents that were successfully used to manage 60 cases. The most effective agents were vitamin C, curcumin, vitamin E, quercetin, selenium, chrysin, and garlic extract. Vitamin C showed ameliorating effects in a wide range of toxicities. The exposure mode to pesticide residues, where 1, 2, 3, and 4 are aerial exposure to pesticide drift, home and/or office exposure, exposure due to drinking contaminated water, and consumption of contaminated food, respectively. General cardiotoxicity is represented by 5, whereas 6, 7, 8 and 9 are electrocardiogram (ECG) of hypotension due to exposure to OP residues, ECG of myocardial infraction due to exposure to OPs, ECG of hypertension due to exposure to OC and/or PY, and normal ECG respectively.
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Affiliation(s)
- Yasser El-Nahhal
- Department of Earth and Environmental Science Faculty of Science, The Islamic University-Gaza, Gaza, Palestine.
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Cao Y, Ibáñez Navarro A, Perrella L, Cedergreen N. Can Organophosphates and Carbamates Cause Synergisms by Inhibiting Esterases Responsible for Biotransformation of Pyrethroids? ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:1585-1593. [PMID: 33470798 DOI: 10.1021/acs.est.0c04493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hydrolysis catalyzed by general esterases (GEs) is the most efficient route for hydrolyzation of pyrethroid insecticides. Organophosphate (OP) and carbamate (CB) insecticides are known to inhibit GEs in addition to acetylcholinesterase (AChE), which is their main target. We hypothesize that synergies can be induced by OPs and CBs when mixed with pyrethroids, due to their inhibition of GE-dependent detoxification of pyrethroids. To test this hypothesis, we conducted mixture toxicity experiments with Daphnia magna using α-cypermethrin (α-cyp) in combination with the noninsecticidal OP tetraisopropyl pyrophosphoramide (iso-OMPA) and five AChE inhibitors diazinon, chlorpyrifos, chlorfenviphos, parathion, and aldicarb. In addition, the in vivo GE activity inhibition was measured for all compounds. Up to 10-fold synergy was found between α-cyp and iso-OMPA, and the degree of synergy correlated linearly with the inhibition of the GE activity. No synergy, however, was found in any of the insecticide mixtures nor was the GE activity inhibited within the nonlethal concentration range tested. It was concluded that the effect of the insecticides on AChE occurred at lower concentrations than their effect on GEs, making the daphnids become immobilized before any synergistic effects on mortality could be observed. The implications of the findings are discussed from a risk assessment perspective.
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Affiliation(s)
- Yi Cao
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark
| | - Alberto Ibáñez Navarro
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark
| | - Lucas Perrella
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark
| | - Nina Cedergreen
- Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark
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Abstract
Introduction Pyrethroid compounds are widely used as insecticides. These compounds not only have a versatile application, but also have favourable toxicological profiles with high selectivity and toxicity to insects and low toxicity to humans. Despite this, there have been several reports of toxicity to humans in both occupational exposure and deliberate ingestional poisoning. Classical presentation and treatment Two classical syndromic presentations are described. Type I syndrome is characterised predominantly by tremors and is seen with exposure to type I pyrethroids. Type II pyrethroids, which are structurally modified type I pyrethroids with the addition of a cyano group, can result in type II syndrome characterized by choreo-athetosis and salivation. Mega-dose poisoning and mixed poisoning, particularly with organophosphorus compounds, is associated with significant toxicity and death. Treatment is supportive and symptomatic. A favourable outcome can be expected in most patients. How to cite this article Ramchandra AM, Chacko B, Victor PJ. Pyrethroid Poisoning. Indian J Crit Care Med 2019;23(Suppl 4):S267–S271.
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Affiliation(s)
- Atul M Ramchandra
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Binila Chacko
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Peter J Victor
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Kerai S, Gupta B, Khan I. Organophosphate–pyrethroid combined poisoning may be associated with prolonged cholinergic symptoms compared to either poison alone. Indian J Anaesth 2018; 62:903-905. [PMID: 30532330 PMCID: PMC6236780 DOI: 10.4103/ija.ija_338_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Binary combinations of organophosphorus and synthetic pyrethroids are more potent acetylcholinesterase inhibitors than organophosphorus and carbamate mixtures: An in vitro assessment. Toxicol Lett 2017; 268:8-16. [DOI: 10.1016/j.toxlet.2016.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/04/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022]
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Srinivasan M, Amin R, Thunga G, Nagiri SK, Kudru CU. Pharmacokinetic Potentiation of Mixed Organophosphate and Pyrethroid Poison Leading to Prolonged Delayed Neuropathy. J Clin Diagn Res 2016; 10:FD01-FD02. [PMID: 28050396 DOI: 10.7860/jcdr/2016/22756.8773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
Organophosphate (OP) and mixed pesticide poisoning remains an important cause of hospital admission. Therefore, physician must be aware of atypical presentations of delayed neurological complications of poisoning by taking proper patient history. We report a case of a 23-year-old female who presented with high stepping gait and muscle wasting in hands. Patient history revealed consumption of approximately 4ml of mixed pesticide, consisting of 50% chlorpyrifos with synthetic pyrethroid, 5% cypermethrin. The prolonged and severe nature of delayed peripheral neuropathy, persisting at two years of follow-up, suggests that even small quantities of OP taken in combination with a pyrethroid can result in significant morbidity and is irreversible.
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Affiliation(s)
- Meenakshi Srinivasan
- Intern, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal, Karnataka, India
| | - Ruhul Amin
- Postgraduate Student, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal, Karnataka, India
| | - Girish Thunga
- Assistant Professor (Senior Scale), Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University , Manipal, Karnataka, India
| | | | - Chandrashekar Udyavara Kudru
- Associate Professor, Department of Medicine, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
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Iyyadurai R, Peter JV, Immanuel S, Begum A, Zachariah A, Jasmine S, Abhilash KPP. Organophosphate-pyrethroid combination pesticides may be associated with increased toxicity in human poisoning compared to either pesticide alone. Clin Toxicol (Phila) 2014; 52:538-41. [DOI: 10.3109/15563650.2014.909933] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aissaoui Y, Kichna H, Boughalem M, Kamili ND. [An intoxication can hide another one more serious. Example of a fatal poisoning with ethylene glycol intoxication masked by a pyrethroid insecticide]. Pan Afr Med J 2013; 14:128. [PMID: 23734273 PMCID: PMC3670196 DOI: 10.11604/pamj.2013.14.128.2205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/18/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Younès Aissaoui
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, Université Cadi Ayyad, Marrakech
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Vale A, Bradberry S, Proudfoot A. Clinical Toxicology of Insecticides. MAMMALIAN TOXICOLOGY OF INSECTICIDES 2012. [DOI: 10.1039/9781849733007-00312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Some insects compete for our food, some damage construction materials and some are important disease vectors in humans and animals. Hence, it is not surprising that chemicals (insecticides) have been developed that kill insects and other arthropods. More recently introduced insecticides, such as the neonicotinoids, have been produced with the intent that humans and animals will not be harmed by their appropriate use. This chapter reviews the clinical features and management of exposure to organophosphorus (OP) and carbamate insecticides, neonicotinoids, phosphides and pyrethroids. In the developing world where the ambient temperature is often high and personal protection equipment often not worn, poisoning particularly from OP and carbamate insecticides is common in an occupational setting, though more severe cases are due to deliberate ingestion of these pesticides. Both of these insecticides produce the cholinergic syndrome. The neonicotinoids, a major new class of insecticide, were introduced on the basis that they were highly specific for subtypes of nicotinic receptors that occur only in insect tissues. However, deliberate ingestion of substantial amounts of a neonicotinoid has resulted in features similar to those found in nicotine (and OP and carbamate) poisoning, though the solvent in some formulations may have contributed to their toxicity. Phosphides interact with moisture in air (or with water or acid) to liberate phosphine, which is the active pesticide. Inhalation of phosphine, however, is a much less frequent cause of human poisoning than ingestion of a metal phosphide, though the toxicity by the oral route is also due to phosphine liberated by contact of the phosphide with gut fluids. It is then absorbed through the alimentary mucosa and distributed to tissues where it depresses mitochondrial respiration by inhibiting cytochrome c oxidase and other enzymes. Dermal exposure to pyrethroids may result in paraesthesiae, but systemic toxicity usually only occurs after ingestion, when irritation of the gastrointestinal tract and CNS toxicity, predominantly coma and convulsions, result.
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Affiliation(s)
- Allister Vale
- National Poisons Information Service (Birmingham Unit) City Hospital, Birmingham UK. *
- West Midlands Poisons Unit City Hospital, Birmingham UK
- School of Biosciences and College of Medical and Dental Sciences University of Birmingham, Birmingham UK
| | - Sally Bradberry
- National Poisons Information Service (Birmingham Unit) City Hospital, Birmingham UK. *
- West Midlands Poisons Unit City Hospital, Birmingham UK
- School of Biosciences and College of Medical and Dental Sciences University of Birmingham, Birmingham UK
| | - Alex Proudfoot
- National Poisons Information Service (Birmingham Unit) City Hospital, Birmingham UK. *
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Yavuz O, Aksoy A, Das YK, Gulbahar MY, Yarim GF, Cenesiz M, Atmaca E, Guvenc D. Repeated-dose 14-day dermal toxicity of different combinations of some synthetic pyrethroid insecticides, piperonyl butoxide, and tetramethrin in rats. Cutan Ocul Toxicol 2009; 29:16-25. [DOI: 10.3109/15569520903415076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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