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Index of Signs and Symptoms of Acute Poisoning

This index provides a table of and their related symptoms and signs and affected organ systems in poisoned individuals. This may be useful in raising the index of suspicion for toxicity where these signs and symptoms occur. Such suspi- cion can be evaluated further within the differential diagnosis as appropriate. It is important to keep in mind that the signs and symptoms listed have multiple causes, pesticidal and nonpesticidal. In addition, no specific symptoms or signs are invariably present in poisonings by particular pesticides. Toxicological presentation Common symptoms may vary based on dosage, route(s) of exposure, stage of the patient, and patient’s were not included: genetic vulnerability, co-exposures and/or underlying health status. This complexity may explain why many poisonings are characterized by unexpected or atypical mani- • malaise festations. • fatigue It is important to keep in mind that the signs and symptoms • dizziness listed have multiple causes, pesticidal and nonpesticidal. • nausea The table does not differentiate clinical presentation by route of exposure or • dosage. For example, effects of high-dose ingestion are not distinguished from effects of relatively low-dose dermal absorption, nor are topical effects distinguished from systemic dermal manifestations. Such details are addressed more fully in the chapters addressing the specific pesticides, which make up the bulk of this manual. The list of pesticides in this chapter is intended to serve as a clue for the clinician toward further inquiry. The word “poisoning” is used loosely in these headings to include topical as well as systemic effects that are acute manifestations rather than delayed sequelae or chronic conditions, although in some cases acute effects may persist. For chronic health conditions including long-term sequelae after acute poisoning and chronic conditions associated with lower level, repeat exposures, see Chapter 21, Chronic Effects. Pesticides that are relatively consistent in causing particular manifestations are listed in the column headed “Characteristic of These Poisonings.” Agents that are associated with conditions less consistently or are less prominent features of poisoning are listed in the right-hand column, headed “May Occur in These Poisonings.” Obvi- ously, the distinction is not always clear cut. Some symptoms (malaise, fatigue, dizziness, nausea and vomiting) occur so commonly in poisoned individuals that they have little or no value in differential diag- nosis, and are therefore not included in these tables.

244 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Rotten egg odor

Hypothermia Creosote

Hyperthermia Borate (fever, pyrexia) Pentachlorophenol Thallium Metaldehyde Inorganic Chlorophenoxy compounds Cadmium dusts

Chills Hot sensations Nitrophenols Pentachlorophenol Chlordimeform

Myalgia General and Chlorophenoxy Non-Specific compounds Thirst Pentachlorophenol Borate Nitrophenols Endothall Inorganic arsenicals Phosphorus Phosphides Sodium Fluoride Cholecalciferol Aminopyridine

Anorexia Organophosphates Halocarbon fumigants N-methyl Nitrophenols SYSTEM: General/Non-Specific Inorganic arsenicals Pentachlorophenol Amino Hexachlorobenzene Chlordimeform Cholecalciferol

Alcohol intolerance Thiram Calcium

Sweet taste in the mouth Chlordimeform

Metallic taste in the mouth Inorganic arsenicals Organic mercury

Salty, soapy taste Sodium fluoride In the mouth

245 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Irritation, rash, Copper, organotin, and Pentachlorophenol blistering, or cadmium compounds erosion (without sensitization) Chlorophenoxy Paraquat Captan Sodium chlorate Diethyltoluamide (DEET) Phosphorus Creosote Sulfur Fungicides Thiram with irritant Chlordimeform properties Cationic detergents Petroleum distillate Hexachlorophene oxide Methyl bromide Skin Ethylene dibromide Dibromochlorpropane Dichloropropane Endothall Aliphatic acids Contact dermatitis PCP Barban Paraquat Captafol DEET Formaldehyde Chlorhexidine Creosote SYSTEM: Skin Hexachlorophene Pyrethrins/pyrethroids Chlorothalonil Thiram Thiophthalimides Propargite Flushing Cyanamide Thiram plus

Beefy red palms, soles Borate

Urticaria Chlorhexidine Fluoride PCP Pentachlorophenol DEET Bullae Liquid fumigants Hexachlorobenzene

Pallor Organochlorines Coumarins Fumigants Indandiones Sodium fluoride Creosote

246 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Cyanosis Sodium chlorate Organophosphates Paraquat N-methyl carbamates Cadmium dusts Sodium fluoroacetate Nicotine Organochlorines

Yellow stain Nitrophenols

Keratoses, brown Inorganic arsenicals discoloration

Ecchymoses Coumarins Phosphorus Skin Indandiones Phosphides

Jaundice tetrachloride Inorganic arsenicals Diquat Phosphorus Copper compounds Phosphides Phosphine Paraquat Sodium chlorate SYSTEM: Skin, cont. Excessive hair growth Hexachlorobenzene

Loss of hair Thallium Inorganic arsenicals

Loss of fingernails Paraquat Inorganic arsenicals

Brittle nails, white striations Inorganic arsenicals Thallium

Sweating, diaphoresis Organophosphates Copper compounds N-methyl carbamates Nicotine Pentachlorophenol Naphthalene Aminopyridine

247 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Conjunctivitis Thiophthalimides (irritation of mucous Acrolein Thiram membranes, tearing) Copper compounds Thiocarbamates Organotin compounds Pentachlorophenol Cadmium compounds Chlorophenoxy Metam sodium compounds Paraquat Chlorothalonil Diquat Picloram Acrolein Creosote Chloropicrin Aliphatic acids Strobilurin fungicides Naphthalene Pyrethrins Formaldehyde Ethylene oxide Methyl bromide Endothall Eye Toluene Xylene

Lacrimation (muscarinic) Organophosphates N-methyl carbamates

Yellow sclerae Nitrophenols Agents that cause jaundice SYSTEM: Eye (see section on Skin)

Keratitis Paraquat

Ptosis Thallium

Diplopia Organophosphates N-methyl carbamates Nicotine

Photophobia Organotin compounds

Constricted visual fields Organic mercury

Optic atrophy Thallium

Miosis Organophosphates Nicotine (early) N-methyl carbamates

Dilated pupils Cyanide Nicotine (late) Fluoride

Non-reactive pupils Cyanide

248 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Paresthesia Pyrethroids Organophosphates Organochlorines Thiabendazole Phosphides Inorganic arsenicals Sodium fluoroacetate Organic mercury Thallium Carbon disulfide Pyriminil

Headache Organophosphates Organochlorines N-methyl carbamates Nitrophenols Nicotine Thiram Inorganic arsenicals Pentachlorophenol Organic mercury Paraquat Cadmium compounds DEET Organotin compounds Copper compounds Nervous Thallium System Fluoride Borates Naphthalene Phosphine Halocarbon fumigants Creosote Diquat Cholecalciferol Cyanamide Neonicotinoids Fipronil SYSTEM: Nervous System

Behavioral – mood Organic mercury Organophosphates disturbances Inorganic arsenicals N-methyl carbamates (confusion, excitement, Organotin compounds Pentachlorophenol mania, disorientation, Sodium fluoride emotional lability) Thallium Nicotine DEET Sodium fluoroacetate Organochlorines Diquat Neonicotinoids Cyanide Nitrophenols Aminopyridine Carbon disulfide Methyl bromide Fipronil

249 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Depression, stupor, coma Organophosphates Inorganic arsenicals N-methyl carbamates Metaldehyde (particularly in children) Sodium fluoride Halocarbon fumigants Borate Phosphorus Diquat Phosphine Fipronil Paraquat Avermectins Chlorophenoxy compounds DEET Alkyl phthalates

Seizures/convulsions Organochlorines Nitrophenols (clonic-tonic) sometimes Strychnine Pentachlorophenol leading to coma Nervous Crimidine Inorganic arsenicals System Sodium fluoroacetate Organotin compounds Nicotine Diquat Cyanide Borate Sulfuryl fluoride Metaldehyde Methyl bromide Thallium Chlorophenoxy DEET compounds Chlorobenzilate Organophosphates Carbon disulfide N-methyl carbamates Phosphine Aminopyridine Povidone-iodine Fipronil Hexachlorophene Sodium chlorate

SYSTEM: Nervous System, cont. Creosote Endothall Fluoride

Muscle twitching/ Organophosphates Organic mercury fasciculation N-methyl carbamates Chlorophenoxy Nicotine compounds Sulfuryl fluoride Pyrethroids

Myotonia Chlorophenoxy compounds

Tetany, carpopedal spasms Fluoride Phosphides Phosphorus

250 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Tremor Organic mercury Pentachlorophenol Thallium Nitrophenols Organophosphates Thiram N-methyl carbamates Nicotine Metaldehyde Borates Neonicotinoids Pyrethroids Nervous Incoordination Halocarbon fumigants Organic mercury System (including ) Organophosphates Organochlorines N-methyl carbamates Chlorobenzilate Carbon disulfide Nicotine Thallium Paralysis Inorganic arsenicals Organic mercury Paresis, muscle weakness Organophosphates DEET

SYSTEM: Nervous System, cont. N-methyl carbamates Nicotine Neonicotinoids Hearing loss Organic mercury

Hypotension and shock Phosphorus Inorganic arsenicals Phosphides Nicotine (late) Phosphine Creosote Sodium fluoride Alkyl phthalate Sodium chlorate Cycloheximide Borate Formaldehyde Thallium Copper compounds Endothall Cyanamide Cardiovascular Hypertension Thallium (early) Organophosphates System Nicotine (early) Cardiac arrhythmias Sodium fluoroacetate Inorganic arsenicals Halocarbon fumigants Phosphorus Nicotine Phosphides Sodium fluoride Phosphine Ethylene oxide Organochlorines

SYSTEM: Cardiovascular Sodium chlorate Cyanide Thallium-ventricular Acrylonitrile Povidone-iodine Fluoride Veratrum alkaloid (sabadilla) Neonicotinoids

251 INDEX Signs and Symptoms

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Bradycardia (sometimes to Cyanide Nicotine (late) Cardiovascular asystole) Organophosphates System N-methyl carbamates Tachycardia Nitrophenols Metaldehyde Cyanamide Organophosphates (early, Nicotine (early) before bradycardia) Pentachlorophenol SYSTEM: Cardio, cont. Neonicotinoids

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Upper respiratory tract Naphthalene Dry formulation of copper, irritation, rhinitis, scratchy Paraquat tin, zinc compounds throat, cough Chloropicrin Dusts of thiocarbamate and other organic Acrolein pesticides Dichloropropene Chlorophenoxy Ethylene dibromide compounds Sulfur dioxide Aliphatic acids Sulfuryl fluoride Rotenone Acrylonitrile Formaldehyde Cadmium dusts Pyrethroids Respiratory Strobilurin fungicides System Sneezing Sabadilla Runny nose Pyrethrins/ pyrethroids Dry formulation of copper, Inorganic arsenicals tin, zinc compounds Organophosphates Dusts of thiocarbamate and other organic N-methyl carbamates pesticides Chlorophenoxy compounds Aliphatic acids SYSTEM: Respiratory Rotenone Pulmonary edema Methyl bromide Organophosphates (many chemicals come Phosphine N-methyl carbamates packaged in a hydrocarbon Phosphorus Paraquat vehicle, well known to cause pulmonary edema) Phosphine Phosphides Ethylene oxide Ethylene dibromide Acrolein Pyrethroids Sulfur dioxide Cationic detergents Creosote Methylisothiocyanate Cadmium

252 INDEX Signs and Symptoms

Pulmonary consolidation Paraquat Diquat Cadmium dusts Methyl bromide Dyspnea Organophosphates Nitrophenols Respiratory N-methyl carbamates Cyanide Nicotine Creosote System Paraquat Pyrethrins Cadmium dusts Pyrethroids Cyanamide Sulfuryl fluoride Pentachlorophenol Methyl bromide Sulfur dioxide Chloropicrin SYSTEM: Respiratory, cont. SYSTEM: Respiratory, Neonicotinoids

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Diarrhea (non-bloody) Organophosphates Cationic detergents N-methyl carbamates Cresol Pyrethroids Hexachlorophene Borates Chlorophenoxy Sulfur Nicotine B. thuringiensis Thiram Gastrointestinal Cadmium Avermectins Tract and Diarrhea (bloody) Fluoride Phosphorus Paraquat Phosphides Diquat Cycloheximide Thallium Coumarins Indandiones Endothall Arsenicals

Stomatitis Inorganic arsenicals Thallium Paraquat Diquat Copper compounds Salivation Organophosphates

SYSTEM: and Liver SYSTEM: Gastrointestinal Tract N-methyl carbamates Pyrethroids Nicotine Aminopyridine Sodium fluoride Cyanide Cadmium compounds

253 Signs and Symptoms

Abdominal pain Organophosphates Chlorophenoxy N-methyl carbamates compounds Paraquat Aliphatic acids Diquat Sodium chlorate Nicotine Creosote Metaldehyde Endothall Fluoride Aminopyridine Borate Coumarins Gastrointestinal Phosphorous Indandiones Fumigants (ingested) Tract and Liver Phosphides Inorganic arsenicals Cycloheximide Cadmium compounds Copper compounds Thallium Organotin compounds Neonicotinoids Thallium Pyriminil Diquat SYSTEM: GI Tract and Liver, cont. and Liver, SYSTEM: GI Tract Constipation Pyriminil

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Enlargement Copper compounds Inorganic arsenicals Sodium chlorate Hexachlorobenzene Liver Phosphine Carbon tetrachloride Chloroform

SYSTEM: Liver Jaundice (see section on Skin)

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Proteinuria/hematuria Inorganic arsenicals Cadmium compounds and acute renal failure Copper compounds Phosphorus Sodium fluoride Phosphides Naphthalene Phosphine Borate Chlorophenoxy Kidney Nitrophenols compounds Pentachlorophenol Creosote Sodium chlorate Organotin compounds Sulfuryl fluoride

SYSTEM: Kidney Paraquat Diquat Arsine Ethylene dibromide

254 INDEX Signs and Symptoms

Rhabdomyolysis Neonicotinoids Avermectins Dysuria, hematuria, pyuria Chlordimeform

Polyuria Cholecalciferol Fluoride

Hemoglobinuria Naphthalene Sodium chlorate Arsine Wine-red urine Hexachlorobenzene (porphyrinuria) Kidney Smoky urine Creosote

SYSTEM: Kidney Endothall Glycosuria Organotin compounds

Ketonuria Borate

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Hemolysis Naphthalene Copper compounds Sodium chlorate Cresol Arsine Methemoglobinemia Sodium chlorate Chlordimeform Creosote Cyanide Cresol Metobromuron Copper Blood Arsine Diflubenzuron Nitrophenol Hypoprothrombinemia Coumarins Phosphorus Indandiones Phosphides Carbon tetrachloride Hyperkalemia Sodium chlorate Sodium fluoride Naphthalene Arsine SYSTEM: Blood Hypocalcemia Fluoride Thallium Phosphorus Phosphides Hypercalcemia Cholecalciferol

Carboxyhemoglobinemia Organotin compounds

Anemia Naphthalene Sodium chlorate Arsine Inorganic arsenicals Leukopenia, Inorganic arsenicals

255 INDEX Signs and Symptoms

Elevated LDH Carbon tetrachloride Inorganic arsenicals GOT, GPT, Chloroform Phosphorus alkaline phosphatase, Phosphine Phosphides ALT, AST enzymes Sodium chlorate Nitrophenols Pentachlorophenol Blood Thallium Organochlorines Chlorophenoxy compounds Depressed RBC Organophosphates N-methyl carbamates acetylcholinesterase and plasma SYSTEM: Blood, cont. pseudocholinesterase

SYMPTOMS/ CHARACTERISTIC OF MAY OCCUR IN SIGNS/DISEASE THESE POISONINGS THESE POISONINGS CATEGORIES Low sperm count Dibromochloropropane Kepone

Reproductive System SYSTEM: Reproductive

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