TABLE 2.

Clinical Signs and Symptoms

Class of Compounds	Signs and Symptoms	Special Notes, Laboratory Evaluations, Specific Treatments, or Antidote
Organophosphate and carbamate insecticides	Nonspecific early symptoms: headache, nausea, vomiting, abdominal pain, and dizziness Sometimes hypersecretion: sweating, salivation, lacrimation, rhinorrhea, diarrhea, and bronchorrhea Progressive symptoms: muscle fasciculation, muscle weakness, and respiratory symptoms (bronchospasm, cough, wheezing, and respiratory depression) Bradycardia is typical, although early in acute poisoning, tachycardia may be present Miosis Central nervous system: respiratory depression, lethargy, coma, and seizures	Red blood cell and plasma cholinesterase levels Measure nonspecific metabolites for most OPs Specific metabolites can be measured for chlorpyrifos and parathion Atropine is primary antidote Pralidoxime is also an antidote for OP and acts as a cholinesterase reactivator Because carbamates generally produce a reversible cholinesterase inhibition, pralidoxime is not indicated in these poisonings
Pyrethroids	Dermal: skin irritation and paresthesia Nonspecific symptoms including headache, fatigue, vomiting, diarrhea, and irritability Similar findings found in OPs, including hypersecretion, muscle fasciculation, pulmonary symptoms and seizures	At times have been mistaken for acute OP or carbamate poisoning and treated with atropine with potentially adverse or disastrous results Symptomatic treatment Vitamin E oil for dermal symptoms
Neonicotinoids	Disorientation, agitation—severe enough to require sedation, drowsiness, dizziness, weakness, and, in some situations, loss of consciousness Vomiting, sore throat, abdominal pain Ulcerations in upper GI tract	Supportive care
Fipronil (N-phenylpyrazole insecticides)	Nausea and vomiting Aphthous ulcers Altered mental status and coma Seizures	Supportive care No available antidote No available diagnostic test
Organochlorines	Central nervous system: mental status changes and seizures Paresthesia, tremor, ataxia, and hyperreflexia	Control acute seizures with lorazepam
Glyphosate (phosphonate herbicides)	Nausea and vomiting Aspiration pneumonia type syndrome Hypotension, altered mental status, and oliguria in severe cases Aspiration pneumonia type syndrome Pulmonary effects may in fact be secondary to organic solvent	Supportive care
Chlorophenoxy herbicides	Skin and mucous membrane irritation Vomiting, diarrhea, headache, confusion Metabolic acidosis is the hallmark Renal failure, hyperkalemia, and hypocalcemia	Consider forced alkaline diuresis with sodium bicarbonate in IV fluids
Long-acting anticoagulants (rodenticides)	Bleeding: gums, nose, and other mucous membrane sites Bruising	Consider PT (INR) or observation Vitamin K indicated for bleeding (IV vitamin K) or for elevated PT (INR) (oral vitamin K)

IV, intravenous.