Clinical management of agrochemical poisoning – promising outcome with evidence based practice

Abstract

Pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. It is a major problem in countries like ours where highly toxic organophosphate pesticides and paraquat are available. Medical management is difficult, with case fatality more than 15%. In the early part of this century, little clinical research and evidence existed with which to determine best therapy. Research conducted in Sri Lanka over the last fifteen years has changed the overall management and outcomes. Our main concern is still organophosphates and carbamates. We still do not know how the core treatments—atropine, oximes, should best be given. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids, improve oxygen delivery to tissues, and therefore the final outcome. The role of oximes is not completely clear. Small studies suggest benefit from new treatments such as clonidine, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Some pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality and we have successfully achieved this.