General Measures in the Management of Acute Pesticide Poisoning

Poisoning is an increasing health problem in both industrialized and developing countries and the Philippines is not an exception. An epidemiologic study on acute pesticide poisoning in selected hospitals in four regions in the Philippines was conducted by the University of the Philippines-National Poison Control and Information Service (NPCIS) in 2000-2001. Data showed that there were a total of 328 pesticide poisoning cases admitted from a total of 789 poisoning cases from 34 hospitals. Majority (87% ) of cases were intentional in nature with 17.5% of patients presenting with moderate-severe manifestations. The commonly encountered pesticides were pyrethroids (27.2%), organophosphates (18.0%), carbamates (9.5%), mixed pesticides (7.9%) and chlorophenoxy compounds (4.0%). The average duration of hospital stay in majority of cases was 1-2 days. Mortality rate was 5.8% with organochlorine poisoning having the highest case fatality rate ( 22.2%).

Management of acute pesticide poisoning in these hospitals were deficient. Skin decontamination was done in only 13.4% of cases and 26.8% received activated charcoal as lavage. Atropine was administered in 58.5% of cases, with no indication at all in cases of organochlorine, anticoagulant and bipyridyl poisoning.

At the Philippine General Hospital, there were 78 admissions out of a total of 1,112 poisoning cases seen from April 2000 - March 2001 with 80.8% intentional in nature. The most commonly encountered pesticides were mixed pesticides (39%) containing organophosphates, carbamates and pyrethroids followed by rodenticides in 15% of cases. Majority (62.8%) presented with minor signs and symptoms of poisoning. Mortality rate was 2.6%. In 2002, pesticide poisoning ranked 2nd among the 2,848 poisoning cases referred to the poison information service. Thirty two percent of such cases were secondary to mixed household pesticides.

Among pesticide poisoning cases, better health outcome is dependent on the early recognition of poisoning and subsequent institution of the appropriate management. Less complications are observed and hospital stay is shorter when pesticide poisoning is earlier recognized. Thus, knowing the characteristics of pesticides and understanding the general principles in treating pesticide poisoning cases, with emphasis on the indications and contraindications, are of utmost importance for patient survival.