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RECOGNITION AND FIRST AID PROCEDURES FOR

PESTICIDE POISONING
(FIELD SETTING)
I.

INTRODUCTION

Pesticide poisoning cases are emergencies and should be eventually managed by a

physician in an appropriate medical facility. This medical emergency situation poses a
big problem in remote agricultural areas where there is heavy usage of pesticides but
where there are no medical facilities. Primary health workers in these areas should be
trained and well-equipped in the recognition and first-aid management of pesticide
poisoning cases.
Mortality from pesticide poisoning has been decreasing for the past several years
probably due to banning or restricting the availability of several pesticides with high
toxicity and the availability of newer and less hazardous pesticides. In addition, pesticide
safety programs (safe and judicious use of pesticides, integrated pest management, etc.)
may have contributed to a decrease in the incidence of occupational pesticide poisoning
cases. However, there has recently been an increase in the incidence of suicidal cases in
some areas in Benguet, where ingestion of pesticides is often preferred.
The importance of early recognition of pesticide poisoning cannot be
overemphasized since non-recognition of mild signs and symptoms can end up in
disastrous severe manifestations resulting to death. First aid procedures administered as
soon as the illness is recognized could spell out the big difference in saving the life of the
victim.

II.

RECOGNITION OF PESTICIDE POISONING

Recognition or arriving at a correct diagnosis of pesticide poisoning can be

achieved by the following:
1. Clinical diagnosis based on a history of pesticide exposure and the appearance
of signs and symptoms compatible with time-dose relationship.
2. Laboratory confirmation like cholinesterase activity determination, pesticide
and/or metabolite studies in the blood and urine and intact pesticide studies.
Identifying pesticide poisoning cases by clinical method can be done anywhere and
could be the only option in remote areas where medical laboratory facilities do not exist.
A well-trained primary health worker could diagnose a pesticide poisoning case
accurately by clinical method. Portable diagnostic kits for pesticide poisoning are quite
helpful in remote areas if available. Well-preserved, well-packaged biological samples

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(e.g. blood, serum, urine) may be sent (timely transport) to well-equipped laboratories
for the laboratory confirmation of poisoning.
Pesticides belonging to the same chemical group can cause similar signs and
symptoms, which may be mild, moderate or severe, depending on the degree of
exposure. However, it is important to distinguish signs and symptoms of pesticide
poisoning from those that may be due to other causes. Headache and a feeling of being
unwell, for example may signal the start of another kind of illness. It is the pattern of the
manifestations that makes it possible to distinguish between pesticide poisoning and
other sickness.
A.

INSECTICIDES

1. Organophosphates and Carbamates both inhibit the enzyme cholinesterase causing

overstimulation of the nerves. Carbamates are short-acting cholinesterase
inhibitors compared to organophosphates. Therefore, in general, carbamates are
less toxic than organophosphates.
Examples:
Organophosphates: malathion, metamidophos, chlorpyrifos
Carbamates: carbofuran, carbaryl, methomyl, propoxur
MILD signs and symptoms:
-

Diarrhea
Urination (frequent and involuntary urination)
Miosis (diminished pupil size of the eyes)
Bradycardia
(slow heart beat - < 60 beats/min)
Excessive sweating
Lacrimation (excessive tearing of eyes)
Salivation

MODERATE signs and symptoms:

- Inability to walk
- Pinpoint pupils
- Chest discomfort and tightness
- Muscle twitching
SEVERE signs and symptoms:
- Unconsciousness
- Local or generalized convulsions
- Previously mentioned signs and symptoms
2. Pyrethroids specific nerve stimulators on lower animals (e.g. insects, fishes, etc.). In
general, pyrethroid insecticides have low toxicity in humans. In recent years, they
are the most popular type of insecticides being used in agriculture and public
health. Due to their low toxicity, survival rate from pyrethroid poisoning is quite

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high even without specific antidotes. Adverse health effects expected from
pyrethroids exposure are irritation (skin and mucous membranes) and allergic
reactions (including asthma). For chronic high exposures, certain pyrethroids can
cause nerve damage resulting to muscle paralysis. Regular intake of vitamin E is
suggested to prevent this adverse chronic effect.
Examples: permethrin, cypermethrin, deltamethrin
Signs and Symptoms:
- irritation of skin and mucous membranes
- allergic reactions (redness and itchiness of skin, sneezing, runny nose,
asthma)
- occasionally dizziness, headache, nausea, anorexia, fatigue
- sometimes salivation, convulsions, abnormal facial sensations, tremors
3. Organochlorines powerful nervous system stimulators. Locally, there are no more
organoclorine pesticides registered for use.
4. Other Insecticides (including biologicals) in recent years, several new types of
insecticides have been made available in the market. In general, due to more
stringent international regulatory requirements, the new insecticides are less toxic
and more environmentally friendly. Many of these new insecticides belong to the
green label category (least hazardous) of the Hazard Classification.
Examples: imidacloprid (Confidor), spinosad (Success), fipronil (Regent)
abamectin (Agri-Mek), Bacillus thuringiensis (biologicals)
Signs and symptoms:
-

non-specific signs and symptoms

some can cause minor skin and eye irritation
allergic reactions to sensitive persons
no reports of serious poisoning cases

B. HERBICIDES
- arrest or prevent the growth of weeds (unwanted plants)
- composed of many chemical groups
- generally, low toxicity to humans
1. Chlorophenoxy compounds at high doses, can cause serious nerve, liver and kidney
damage leading to death. It is also mildly to severely irritating to the skin and
mucous membranes. It has no antidote.
Examples: 2-4 D (broad-leaf herbicide)

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Signs and symptoms:
- irritation and burning
sensation on skin and
mucous membrane
- cough
- dizziness
- inability to coordinate
muscle movements

- chest pain
- abdominal pain
- diarrhea
- muscle twitching
- skeletal muscle tenderness
and stiffness

2. Bipyridyls when orally ingested, survival rate is low because it causes serious
damage to many internal organs, especially the lungs. Fullers earth, as an
adsorbent, if given very early, after ingesting paraquat, may increase the chances
of survival. If Fullers earth is not available immediately, activated charcoal is a
good substitute. The importance of the immediate or early administration of such
adsorbents cannot be overemphasized.
Examples: paraquat (contact herbicide)
Signs and symptoms:
- Skin exposure irritation, discoloration and irregularity of fingernails
- Eye exposure
- Inhalation

conjunctivitis and eye injury

irritation of nose and throat, sometimes with bleeding

- Oral ingestion mouth, chest and abdominal pain, vomiting and diarrhea,
muscle
aching, scanty urination, , jaundice, cough, difficult and
fast
breathing. The lung complications usually progresses to
death.
3. Other herbicides most other herbicides belong to Category 4 (green label least
hazardous) of the Hazard Category. No significant poisonings from the use of these
herbicides have been reported. Like any other compounds, some of these
herbicides can cause mild irritation (skin and eyes) and possible allergic reactions
to sensitive individuals.
Examples: bensulforon, butachlor, oxadiazon

C. FUNGICIDES

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-

prevents the growth of fungus that causes plant diseases

composed of several chemical groups
low acute toxicity to humans
some have controversial adverse chronic effects.

1. Dithiocarbamates the issue about these compounds is the presence of ethylene

thiourea (ETU), a breakdown product of Mancozeb. ETU has been shown to
cause cancer in rats but is not classifiable as carcinogen in humans (Cat. III
under the IARC Classification). . However, these compounds still have the
potential to cause mild irritation (skin and eyes) and allergic reactions.
Examples: Mancozeb, Maneb
Signs and symptoms:
- skin and eye redness
- allergic reactions (skin itchiness, runny nose, asthma, etc.)
- other non-specific signs and symptoms if ingested
2. Other fungicides most other fungicides belong to Category 4 (green label least
hazardous) of the Hazard Category. No significant serious poisonings from the
use of these fungicides have been reported. Like any other compounds, some
of these fungicides can cause mild irritation (skin and eyes) and possible
allergic reactions to sensitive individuals.
Examples: propiconazole, captan, difenoconazole, chlrothalonil, copper
compounds
D. RODENTICIDES - used to eradicate rats and mice that feed on food crops. They are
classified as fast acting- and slow acting rodenticides.
1. Zinc phosphide (Fast Acting Rodenticide) - when ingested, this type of rodenticide
releases phosphine gas that causes damage to the gastrointestinal tract, liver
and kidneys. There is no antidote. Treatment is symptomatic.
Signs and symptoms:
- nausea
- vomiting
- difficulty in breathing
- headache
- lightheadedness
- convulsions
2. Anti-coagulants (Slow-Acting Rodenticides) - blocks the function of vitamin K
necessary for prothrombin formation. In turn, prothrombin is needed for normal
blood clot formation during bleeding. As a result, spontaneous and prolonged

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bleeding can occur during anticoagulant poisoning. It can also cause capillary
damage. Antidote is vitamin K.
a)
First-generation anti-coagulants - multiple doses are required before
serious toxicity develops
Examples: warfarin (Dora rat killer), coumatetralyl (Racumin), diphacinone
b)
Second-generation anti-coagulants - requires single dose to cause
mortality in rats.
Examples: brodifacoum (Klerat)
Early signs and symptoms:
- skin rashes
- nose bleed
- hematoma
Late signs and symptoms:
- bloody stool, urine, and vomit
- massive internal hemorrhage
E. OTHER PESTICIDES (botanical extracts, attractants, biologicals, IGR, GMO)
- at present, there are no documented reports of significant adverse health effects.
Examples:
Botanicals Neem tree extract, citronella extracts
Attractants - eugenol
Biologicals Bacillus thuringiesis
Insect Growth Regulator (IGR) hexaflumuron (Sentricon)
Genetically Modified Organism (GMO) Bt Corn, glyophosate-resistant Corn

III.

FIRST AID PROCEDURES FOR PESTICIDE POISONING

Before describing the procedures of first aid management in connection with the
use of modern pesticides, it is important to emphasize that whenever pesticides are
stored, handled or used, the following first aid supplies should be on hand:
1. a supply of clean water
2. a mild soap and rags for washing of the skin

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3. home type remedies or antidotes which can be used prior to transporting the
victim
to a medical facility (activated charcoal, Fullers earth).
3. ambu-bag
4. gloves (protection for rescuer)
First aid is the initial effort to assist a victim while medical help is on the way. The
first step you should take in any poisoning emergency, except when you are alone with
the victim, is to call for a physician and/or ambulance or any vehicle which can transport
the patient to the nearest hospital or clinic,
If you are alone with the victim, check if he is conscious, has adequate pulse, is
breathing regularly and that no further exposure occurs. If stable but unconscious,
protect the airway of the victim by loosening his clothing and removing the foreign
objects inside the mouth (e.g. false dentures). Also, positioning the victim sideways
(including the head) will prevent the tongue in obstructing the airway, helps avert
aspiration and avoid build-up of saliva or secretions in the throat.
For poisoning victims who orally ingested very toxic pesticides, applying mouth-tomouth may present a potential serious hazard to the rescuer. It is recommended that the
rescuer use resuscitation equipments like ambu bag or resuscitation mask to prevent
self-contamination. If no such gadgets are available, wiping the contaminated mouth of
the victim with available clean cloth may minimize the risk of poisoning to the rescuer.
The prone (or Schaefer) method or back-pressure arm-lift method.of artificial
respiration may be tried but doing simultaneous cardiac compression with either of this
method will be extremely difficult and might compromise the patient. Wearing of
disposable gloves is also recommended for handling poisoning victims.
If breathing and pulse of the victim are absent, very slow or irregular, initiate
cardiopulmonary resuscitation (CPR) immediately. The one man method of doing CPR is
initiated by giving two breathes and followed by 15 cardiac compressions while the two
men method starts by giving one breathe and followed by five cardiac compressions and
so on, stopping only after a few minutes to re-evaluate the victim for presence of good
spontaneous breathing and strong regular pulse.
While you are waiting for the doctor and/or vehicle to arrive, do the following first
aid procedures:
A. SWALLOWED PESTICIDES
Steps:
1. If the pesticide is not known, give any of the following adsorbent agents by
mouth:
Activated Charcoal preferred for all poisonings except cyanide
Dose: 30 gm in 100 ml water (3 tablespoons in glass water) as a
thick suspension, or Fullers earth 15% susp. for paraquat

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If activated charcoal is not available, give beaten egg whites.
Dose: 8 eggs for adults; 4 eggs for children.
Bring the victim to the hospital.
2. If the pesticide is known, induce vomiting if recommended on the label and if
there are
no contraindications.
After vomiting, give activated charcoal in 100 ml of water (3 tablespoons in
glass
of water) or beaten egg whites if there is no charcoal.
Bring victim to the hospital.

Induction of Vomiting
If the identity of the pesticide is known, induce vomiting if recommended on
the label. Either syrup of ipecac or gagging are methods used to promote
vomiting.
contents.

Syrup of Ipecac given by mouth can remove 90 100% of the stomach

Dose: 2 tablespoons for adults; 1 tablespoon for children.

NOTE: Syrup of ipecac, not fluid extract!

Gagging mechanical stimulation of the throat using the index finger to gag. It
is advisable to use the first two fingers of the other hand to force the patients
cheek between his teeth to ensure that he does not bit the index finger. This
procedure can remove 50% of the stomach contents and can be done at once.
As soon as vomiting occurs, or if it does not occur within a few minutes, give the
victim activated charcoal.
Procedures to Avoid in Cases Where Pesticides are Swallowed:
1. Contraindications to induction of vomiting do not induce vomiting if the victim:
a) is drowsy, unconscious or in convulsion the patient could choke to death if
vomiting is
induced.
b) has swallowed a corrosive poison because the chemical will burn the throat
and the mouth as severely coming up as it did going down. Examples are strong

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acids or alkalis such as phenols and alkali salts. The victim will complain of
severe pain and have signs and symptoms of mouth and throat burns.
c) has swallowed a petroleum based pesticide. Most pesticides that come in liquid
formulations are dissolved in petroleum products (xylene, kerosene, etc.) The
words emulsifiable concentrate or EC and solution or S on the pesticide
labels are signals not to induce vomiting if the poison victim has swallowed the
concentrate. If the victim has swallowed a diluted form of these products,
however, he should be forced to vomit immediately.
d) is in her last three months of pregnancy.
2. The use of table salt (NaCl) to induce vomiting should be discouraged
because serious salt poisoning may occur in unsuccessful attempts to induce
vomiting.
3. No more than two doses of syrup of ipecac should be administered because this
drug is injurious to the heart. The fluid extract of ipecac should never be used to
induce vomiting because this is fourteen (14) times more concentrated than the
syrup.
4. Do not give baking soda, sodium bicarbonate and other carbonates in cases
of swallowed acidic pesticides, because this may induce perforation of the
intestines through the sudden release of carbon dioxide.

B. IHALED PESTICIDES
Steps:
1. If the victim is in an enclosed space, do not go in after him without a respirator.
2. Carry the patient (do not let him walk) to fresh air immediately.
3. Open all doors and windows.
4. Loosen all tight clothing.
C. PESTICIDE ON THE SKIN
The faster the pesticide is washed off the victim, the less injury will remit.
Steps:
1. Remove contaminated clothing.

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2. Drench skin with water (shower, hose, faucet, pond, irrigation canal, etc.)
3. Cleanse skin, hair and fingernails thoroughly with plain soap and water.
Detergents and commercial cleansers may enhance the absorption of the
pesticide through the skin. Avoid harsh scrubbing as this procedure also
enhances the absorption of the pesticide.
5. If water and soap are not immediately available, use a dry cloth to blot as much
pesticide as possible off the skin and wash as soon as possible.
6. For chemical burns, immediately cover loosely with a clean soft cloth after
washing with large quantities of running water.
7. Avoid using ointments, greases, oils, powders and other drugs in the first aid
treatment of burns.
D. PESTICIDE IN THE EYE
Steps:
1. Hold eyelids open and wash the eye with a gentle stream of clean running water
immediately.
2. Be careful not to contaminate the other eye if only one eye is involved.
3. Continue washing for 15 minutes.
4. Do not use chemicals or drugs in wash water because these may increase the
extent of the eye injury.
5. Evert first the upper and then the lower lid and cleanse them with a moist
cotton tip to remove any debris.
6. Irrigate the eye once more.
7. Cover the eye with a clean piece of cloth and refer to a physician, preferably an
ophthalmologist.
E. OTHER FIRST AID PROCEDURES
1. Airway Clearance and Positioning it is always imperative to assure a clear
airway by removing any foreign body, like dentures, food and secretions from
the mouth and by placing the victim in a left lateral Trendelenburg position with
head extended and lower than the trunk level by 15 30 degrees.
Maintain this position while waiting for the physician or the vehicle to arrive and
while the victim is being transported to the hospital.

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This position:
a) prevents airway obstruction due to the relaxation of the tongue and other soft
tissues. If the tongue has already slipped into the throat, it must be pulled
forward.
b) prevents the aspiration of vomited material into the respiratory tract.
c) enhances the gravity drainage of respiratory tract secretions.
d) prevents the further transit of stomach contents into the small intestines where
greater absorption of the pesticide can occur in cases of swallowed poisons.
2. Bring the patient to the clinic or hospital.
DONT WASTE TIME, GET MOVING.
3. Maintenance of respiration if breathing movements are inadequate or absent,
apply artificial respiration.
4. Maintenance of Circulation when pulses suddenly disappear and there are no
detectable heart sounds, apply external heart massage.
5. Unconsciousness Never give anything by mouth and make sure that the
tongue is held forward by inserting a small hard blunt object such as a spoon or
a tongue depressor between the tongue and roof of the mouth.
6. Convulsions Insert a padded gag between the jaws to prevent victim from
biting his tongue. Prevent additional injury by placing a pillow or cushion under
his head and preventing him from falling. Remove all dangerous objects from all
around the patient.
7. Fever (feeling too hot) sponge with cold water.
8. Hypothermia (feeling too cold) sponge with cold water
9. Prophylaxis and First Aid Antidotal Medication Atropine sulfate and oximes
should not be taken by pesticide users as a prophylactic measure because they
do not prevent poisoning. In fact, they can create a false sense of security and
delay the administration of first aid procedures and definitive medical
treatment. Atropine sulfate tablets can mask or delay early symptoms of
poisoning and this can be detrimental in at least two days. Workers can go back
to work and get more exposure or, if the worker is taken to a physician who has
not been informed that atropine has been taken, the diagnosis of poisoning can
be missed or delayed. In an acute poisoning emergency, do not use oral
atropine as a first aid measure because the dose is too small and the victim
cannot take medicine by mouth if he is vomiting or stuporous.

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10. Identification of Pesticide If at all possible, take the pesticide container or
label with you to the physician. If this is impossible, make sure you know what
pesticides the victim has been using.
REFERENCES:
1. Maat, Ma. Mercy, Lecture on Prevention and First Aid Management of Pesticide
Poisoning Cases, 2000.
2. Maramba, Nelia, Handouts on Pesticide Poisoning, 1990
3. Hartigan-Go, Kenneth, Handouts on Emergency Management of Pesticide
Poisoning, 1995
4. Zapatos, Carlos, Handouts on Recognition and First Aid Procedures for Pesticide
Poisoning, 1983