Differential Diagnoses:Could it be a pesticide?

Pesticide Health Effects Medical Education Database (PHEMED)

The Great Decievers

• Syphilis

• Lupus

• AIDS

• Pesticide Poisonings

Sometimes Easy-Sometimes Hard

• General Bad Feeling– Nausea, weakness, fatigue,

lightheadedness, headache, nausea– Differential Diagnosis

1. Viral illness2. Early onset diabetes3. Incipient malaria4. Dehydration5. Pesticide poisonings

S. Holland ‘07

(Semi) Unique Signs-Symptoms

• Miosis: cholinesterase inhibitors• Mydriasis: cyanide/flouride• Acral and perioral parasthesias: pyrethroids• Yellow skin color: nitrophenols• Hair loss: thallium • Peripheral Neuropathy: arsenic & OP’s• Methemoglobinemia (blue baby): sodium

chlorate, creosote• Skin burn: paraquat

Other Manifestations

• Seizures– Organochlorine insecticides

may cause isolated grand mal seizures

– Late stage organophosphates

– Fipronil• Metabolic Acidosis

– Boric Acid ingestion (scalded baby syndrome)

– Herbicides (glyphosate)• Cardiac Arrythmias

– Organophosphates and Torsade de pontes and bradycardia

• Bloody diarrhea– arsenic-thallium

• Pulmonary edema– organophosphates and

carbamates• Altered mental status

– Several pesticides• Hypermetabolism

– Dinoseb– Pentachlorophenol

Manifest in Multiple Systems

• Nervous – central & peripheral• Cardio-vascular• Gastrointestinal & Hepatic• Skin• Eye• Hematopoietic• Respiratory • Renal