(p. 1568) Management of pesticide and agricultural chemical poisoning 

Poisoning with agricultural chemicals is common in rural Asia-Pacific with up to 300,000 annual deaths from pesticide self-poisoning. The pharmacokinetics and pharmacodynamics of pesticides can vary markedly depending on the chemicals ingested, the pesticide’s lipid solubility, enzyme reactivation, co-ingested toxicants, and extent of decontamination and organ dysfunction. Diagnosis and management is based on clinical signs and standard investigations. Staff should wear standard universal precaution attire for examining and treating patients; nosocomial poisoning is rare. Management of poisonings should include careful airway intervention and administration of oxygen, except in suspected paraquat poisoning. Organophosphorus insecticide poisoning causes a cholinergic crisis with excess airway secretions and acute respiratory failure. Patients should be treated with intravenous atropine and observed for the neuromuscular disorder ‘intermediate syndrome’, which can cause further paralysis and respiratory failure after 24 hours. Few antidotes exist for other agricultural chemical poisonings with the mainstay of treatment being supportive standard ICU care.