J Korean Soc Emerg Med.  2021 Dec;32(6):627-635.

The outcomes of pesticide poisoning in accordance with toxicity grade: is the slightly hazardous toxicity not harmful?

• Lim GT
• Kim HI

Abstract

Objective
Emergency physicians frequently encounter suicidal attempt patients. Some of the patients are intoxicated with the pesticides. Unlike medical drugs, finding out detailed information in terms of human toxicity is not easy. In Korea, there is the crop protection substance guidebook, and the toxicity grade is noted in that book. However, little is known about the patients’ characteristics and outcomes with slightly hazardous substances.
Methods
This is a retrospective, single-center study. The study duration was 2 years. We investigated the pesticideintoxicated patients who visited our emergency department. The patients were divided according to toxicity grades, including slightly hazardous, moderately hazardous, highly hazardous and extremely hazardous. Initial vital signs, mental status, laboratory values, therapeutic modalities and therapeutic outcomes were investigated.
Results
Among a total of 472 patients, 110 (23.3%) were pesticide-intoxicated patients. Intensive care unit (ICU) admission rate and mortality rate were higher, and ICU admission duration was longer in the pesticide-intoxicated patients. The deterioration of initial arterial blood gas values (41.2%), hypokalemia or hyperkalemia (32.4%), acute kidney injury (17.6%), troponin elevation (8.8%), and rhabdomyolysis (3.4%) were noted in the slightly hazardous group. Continuous renal replacement therapy, endotracheal intubation and vasopressor use were performed in some of them. The seizure, shock and cardiac arrest were also developed. More than half of patients (52.9%) were admitted to the ICU.
Conclusion
Significant limitation of relying on the toxicity grade was noted. In the low-grade toxicity pesticide group, some patients were deteriorated. Therefore, caution is needed when treating pesticide intoxication patients.

Keyword

Poisons; Poisoning; Toxicology; Pesticides; Suicide