PHEMED - Pesticide Health Effects Medical Education Database

...because open source matters

  • Increase font size
  • Default font size
  • Decrease font size


  BY case2 BY Tool Box Additional Resources2





CASE 1: Oral Herbicide (Diquat) Exposure

  1. Jones, Giselle M. and J. Allister Vale. Mechanisms of Toxicity, Clinical Features, and Management of Diquat Poisoning: A Review. Clinical Toxicology 2000;38(2):123-128.
  2. Lock, Edward A. and Martin F. Wilks. Diquat. In: Krieger, Robert I. (ed). Handbook of Pesticide Toxicology, 2nd ed. Volume 2. San Diego, CA: Academic Press, 2001, pp. 1605-1621.
  3. Lock, Edward A. and Martin F. Wilks. Paraquat. In: Krieger, Robert I. (ed). Handbook of Pesticide Toxicology, 2nd ed. Volume 2. San Diego, CA: Academic Press, 2001, pp. 1559-1603.
  4. Reigart, Routt J. and James R. Roberts. Recognition and Management of Pesticide Poisonings, 5th ed. Washington, DC: Office of Pesticide Programs, U.S. Environmental Protection Agency, 1999, pp. 108-117.
  5. Saeed, S.A.M., M.F. Wilks, and M. Coupe. Acute Diquat Poisoning With Intracerebral Bleeding. Postgrad. Med. Journal 2001;77:329-332
  6. Talbot, Alan. Paraquat and Diquat. In: Brent, Jeffrey et al (eds). Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Philadelphia, PA: Elsevier Mosby, 2005, pp. 947-961
  7. U.S. Geological Survey. Diquat- herbicide, 2002 estimated annual agricultural use. Department of the Interior/USGS. 25 Feb 2008.

CASE 2: Organophosphate Exposure in a Fieldworker

  1. Pesticides and Reproduction
  2. Clementi, M., R. Causin, et al. (2007). A study of the impact of agricultural pesticide use on the prevalence of birth defects in northeast Italy. Reprod Toxicol 24(1): 1-8.
  3. Andersen, H. R., I. M. Schmidt, et al. (2008). Impaired reproductive development in sons of women occupationally exposed to pesticides during pregnancy. Environ Health Perspect 116(4): 566-72.
  4. Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, and Cooper GS. (2006) Pesticide exposure and timing of menopause: the Agricultural Health Study. American Journal of Epidemiology. 163(8):731-742.
  5. Farr SL, Cooper GS, Cai J, Savitz DA, Sandler DP. (2004). Pesticide Use and Menstrual Cycle Characteristics Among Premenopausal Women in the Agricultural Health Study. American Journal of Epidemiology, 160(12):1194-204.
  6. Eskenazi B, Marks AR, Bradman A, Harley K, Barr DB, Johnson C, Morga N, Jewell NP. Organophosphate Pesticide Exposure and Neurodevelopment in Young Mexican-American Children. Environmental Health Perspectives. May 2007; 115:792-798.
  7. Bradman A, Schwartz JM, Fenster L, Barr DB, Holland NT, Eskenazi B. Factors predicting organochlorine pesticide levels in pregnant Latina women living in a United States agricultural area. JESEE., 2006, In press.Pesticides and Children
  8. Curl, CL et. Al., Evaluation of Take-Home Organophosphorus Pesticide Exposure among Agricultural Workers and Their Children. Environmental Health Perspectives.  December 2002; 110: A787-A792.

CASE 3: An Endosulfan Poisoning 



CASE 4: Chemical Skin Burn with Paraquat (Herbicide)

  1. Van Wendel de Joode BN, De Graaf IAM, Wesseling C, Kromhout H. Paraquat Exposure of Knapsack Spray Operators on Banana Plantations in Costa Rica. Int J Occup Environ Health. 1996 Oct;2(4):294-304.
  2. Dalvie, MA, White, N, Raine, R, Myers, JE, London, L, Thompson, M, Christiani, DC.  (1999).  Long term respiratory health effects of the herbicide, paraquat, among workers in the Western Cape, Occupational and Environmental Medicine, 56:391–396.
  3. Dinis-Oliveira, RJ, Sarmento, A, Reis,  R,  Amaro, A, Remia, F,  Bastos,ML, Carvalho, F. (2006).  Acute Paraquat Poisoning: Report of a Survival Case Following Intake of a Potential Lethal Dose Pediatric Emergency Care. 22(7):  537-540.
  4. Dinham, B.  (2004),  Why Paraquat should be banned.  Outlooks on Pest Management , December: 268-271.
  5. Hutchinson G, Daisley H, Simmons V, Gordon AN.  (1991).  Suicide by poisoning. : West Indian Medical Journal.  40(2):69-73.
  6. Schenker, MB, Stoecklin, M, Lee, K, Lupercio, R, Zeballos, RJ,  Enright, P,  Hennessy, T,  Beckett, LA, (2004).  Pulmonary Function and Exercise-associated Changes with Chronic Low-Level Paraquat Exposure.  American Journal of Respiratory and Critical Care Medicine, 170: 773–779.
  7. Sittipunt, C. (2005).  Paraquat Poisoning.  Respiratory Care, 50(3): 383-385.
  8. Valcin, M, Henneberger, PK, Kullman, GJ, London, SJ, Alavanja, MR, Sandler, DP, Hoppin, JA, (2007).  Chronic Bronchitis Among Nonsmoking Farm Women in the Agricultural Health Study.  Journal of Occupational and Environmental Medicine,   49(5):574–583.

CASE 5: A Lindane Overexposure

Lindane Treatment:  Risks and Hazards, Pharmacology
  1. Sudakin, DL (2007)  Fatality after a single dermal application of Lindane. Archives of Environmental and Occupational Health, 62(4), 201-203.
  2. Forrester, M., Sievert, J., and Stanley S. (2004). Epidemiology of Lindane Exposures for Pediculosis Reported to Poison Centers in Texas, 1998–2002. Journal of Toxicology, Clinical Toxicology, 42(1):55–60. (Epidemiology)
  3. Reports of adverse events associated with Lindane use – Memo written by Julie Beitz, Director of Drug Safety, United States Department of Health and Human Service, Food and Drug Administration  (Overview of Lindane including report on top 20 adverse events)
Chemical Hazards in the Home
  1. Karr, C.J., Solomon, G.M., Brock-Utne, A.C. (2007).  Health effects of common home, lawn and garden pesticides. Pediatric Clinics of North America, 54, 63-80.
  2. Riffat F, Cheng A. (2009).  Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Diseases of the Esophagus. 22(1):89-94
  3. US EPA.  Children’s Health Protection.
Children’s Risk to Pesticides
General Information
  1. Bouchard M.F., Bellinger D.C., Wright R.O., Weisskopf M.G. (2010).  Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics. 125(6):e1270-7
  2. Garry, V.F. (2004).  Pesticides and children. Toxicology and Applied Pharmacology, 198 (2), 152-163.
  3. Rosas, L.G. & Eskenazi, B., (2008).  Pesticides and child development. Current Opinion in Pediatrics, 20:191-197.
Exposures at Schools
  1. * Alarcon W.A., Calvert G.M., Blondell J.M., Mehler L.N., Sievert J., Propeck M., Tibbetts D.S., Becker A., Lackovic M., Soileau S.B., Das R., Beckman J., Male D.P., Thomsen C.L., Stanbury M. (2005),  Acute illnesses associated with pesticide exposures at schools. JAMA, 294(4), 455-465.
  2. * Naeher L.P., Barr D.B., Rithmire N., Edwards J., Holmes A.K., Needham L.L., Rubin C.S. (2008). Pesticide exposure resulting from treatment of lice infestation in school-aged children in Georgia. Environment International, 35(2), 358-362.
Children’s Environmental Health - General
  1. Landrigan, P.J., Kimmel, C.A., Correa, A., Eskenazi, B.  (2004). Children’s Health and the Environment: Public Health Issues and Challenges for Risk Assessment. Environmental Health Perspectives, 112 (2), 257-265.
  2. Lloyd-Smith, M., Sheffield-Brotherton, B. (2008).  Children’s Environmental Health: Intergenerational Equity in Action—A Civil Society Perspective. Annals of the New York Academy of Sciences. 1140: 190–200.   (Social Issues)
  3. Sattler, B & Davis, ADB.  (2008)  Nurses’ role in children’s environmental health, Pediatric Nursing, 34(4):329-339.

CASE 6: Paresthesias - Is it Diabetes?

  1. Agency for Toxic Substances and Disease Registry. (2003). Public health statement: Pyrethrins and pyrethroids.  Retrieved May 11, 2009, from: 
  2. Bradberry, S. M., Cage, S. A., Proudfoot, A. T., & Vale, J. A. (2005). Poisoning due to pyrethroids. Toxicological Reviews, 24(2): 93-106.
  3. Lamb, J. P. (2007). Pyrethrins and pyrethroids. In K. R. Olson (Ed.), Poisoning and drug overdose (5th ed.).
  4. Proudfoot, A. T. (2005). Poisoning due to pyrethrins.Toxicological Reviews 24 (2):107-113.
  5. Ray, D. E. & Forshaw, P. J.  (2000).  Pyrethroid insecticides: Poisoning syndromes, synergies, and therapy. Clinical Toxicology, 38(2), 95-101.
  6. Sudakin, D. L.  (2004).  Pesticide poisoning from synthetic pyrethroids.  CD Summary, 53, 6.
  7. Watson, W. A., Litovitz, T. L., Klein-Schwartz, W., Rodgers, G. C., Youniss, J., Reid, N. et al. (2004).  2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

CASE 7: A Community Case Study - Farmworker Housing and Exposure

Immigrant Workers in Agriculture
  1. AFL-CIO. (2005). Immigrant workers at risk: the urgent need for improved workplace safety and health policies and programs
  2. McCauley, L.A. (2005).  Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.  AAOHN Journal, 53(7), 313-319.
  3. National Institute for Occupational Safety and Health. NORA document for public review and comment: national agriculture, forestry and fishing agenda.
Pesticide Exposures and Health Effects
  1. Bassil, K.L., Vakil, C., Sanborn, M., Cole, D.C., Kaur, J.S. & Kerr, K.J. (2007).  Cancer health effects of pesticides: systematic review. Canadian Family Physician, 53, 1705-1711.
  2. Calvert, G.M., Karnik, J., Mehler, L., Beckman, J., Morissey, B., Sievert, J., et al. (2008). Acute pesticide poisoning among agricultural workers in the United States, 1998-    2005. American Journal of Industrial Medicine, 51, 883-898.
  3. Sanborn, M., Kerr, K.J., Sanin, L.H., Cole, D.C., Bassil, K.L. & Vakil, C. (2007). Non-cancer health effects of pesticides: systematic review and implications for family doctors. Canadian Family Physician, 53, 1712-1720.
Ecological Model
  1. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development.  American Psychologist, July 1977, 513-531.
  2. Salazar, M.K. & Beaton, R. (2000). Ecological model of occupational stress.  AAOHN Journal, 48(10), 470-479.
  3. Salazar, M.K., Napolitano, M., Scherer, J.A., & McCauley, L.A. (2004). Hispanic adolescent farmworkers’ perceptions associated with pesticide exposure.  Western Journal of Nursing Research, 26(2), 146-166.
  4. Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10(4), 282-298.

CASE 8: A Farmworker Toddler - Assessing Pesticide Exposure Risk

  1. Edelman C., Mandle C. (2010) Health Promotion Throughout the Life Span. 7th Ed St. Louis: Mosby. Ch 19, p 443.
  2. Hagan J., Bright Futures 3rd Ed. National Center for Education in Maternal and Child Health. Also available at
  3. Murrary R., Zentner J., and Yakimo R. (2009) Health Promotion Strategies Through the life Span 8th Ed. Ch 11

CASE 9: A Poisoning in Taiwan from Contaminated Food

  1. Amer, S.M. & Sayed, M.A. (1987) Cytogenetic effects of the insecticide methamidophos in mouse bone
    marrow and cultured mouse spleen cells. Z. Naturforsch. 42C, 21-30.
  2. Bagos, A.C. & Beatty, P.W. (1991) The percutaneous absorption of methamidophos (SX-1757) in male
    rats. Unpublished report from Chevron Chemical Co. Submitted to WHO by Bayer/Tomen.
  3. Bertolazzi, M., Caroldi, S., Moretto, A. & Lotti, M. (1991) Interaction of methamidophos with hen and
    human acetylcholinesterase and neuropathy target esterase. Arch. Toxicol., 65, 580–585.
  4. Bigger, C.A. & Sigler, C.I. (1993) CHO/HGPRT mutation assay—Monitor technical. Unpublished
    report from Microbiological Associates, Inc. Submitted to WHO by Bayer/Tomen.
  5. Blom, H.J. & Tangerman, A. (1988) Methanethiol metabolism in whole blood. J. Lab. Clin. Med., 111,
  6. Bomann, W., Kaliner, G. & Mager, H. (1992) SRA 5172 (c.n. Methamidophos) subchronic dermal
    neurotoxicity study (ninety-day hen study). Unpublished report from Bayer AG, file No. 21428.
    Submitted to WHO by Bayer/Tomen.
  7. Brown, R., Ames, R. & Mengle, D. (1989) Occupational illness from cholinesterase-inhibiting
    pesticides among agricultural applicators in California. Arch. Environ. Health, 44, 1.
  8. Canellakis, E.S. & Tarver, H. (1953) The metabolism of methyl mercaptan in the intact animal. Arch.
    Biochem. Biophys., 42, 446–455.
  9. Carlson, D., Vondruska, J.F. & Fancher, O.E. (1969) Effects of RE 9006-75%SX-171 on the
    cholinesterase activity in the beagle dog. Unpublished report from Industrial Bio-test Laboratories, Inc.
    Submitted to WHO by Bayer/Tomen.
  10. Cavalli, R.D. & Hallesy, D.W. (1968a) Acute oral toxicity of RE 9006 (95%) in mice. Unpublished
    report from Standard Oil Company of California. Submitted to WHO by Bayer/Tomen.
  11. Cavalli, R.D. & Hallesy, D.W. (1968b) Acute oral toxicity of RE 9006 (95%) in rats. Unpublished
    report from Standard Oil Company of California. Submitted to WHO by Bayer/Tomen.
  12. Cavalli, R.D. & Hallesy, D.W. (1968c) Acute dermal toxicity of Monitor technical. Unpublished report
    from Standard Oil Company of California. Submitted to WHO by Bayer/Tomen.
  13. Chen, H.H., Sirianni, S.R. & Huang, C.C. (1982a) Sister chromatid exchanges and cell-cycle delay in
    Chinese hamster V79 cells treated with 9 organophosphorus compounds (8 pesticides and 1 defoliant).
    Mutat. Res., 103, 307–313.
  14. Chen, H.H., Sirianni, S.R. & Huang, C.C. (1982b) Sister chromatid exchanges in Chinese hamster cells
    treated with seventeen organophosphorus compounds in the presence of a metabolic activation system.
    Environ. Mutag., 4, 621–624.
  15. Christenson, W.R. (1991) Technical grade methamidophos (Monitor), an eight-week subchronic
    Pesticide residues in food:2002 - METHAMIDOPHOS cholinesterase study in Fischer 344 rats. Unpublished report from Mobay Chemical Corp. Submitted to
    WHO by Bayer/Tomen.
  16. Crawford, C.R. & Anderson, R.H. (1973) The acute toxicity of Monitor technical in combination with
    malathion technical to female rats. Unpublished report from ChemAgro Division of Baychem Corp.
    Submitted to WHO by Bayer/Tomen.
  17. Crossley, J. & Tutass, H.O. (1969) Metabolism of Monitor insecticide by rats. Unpublished report from
    Chevron Chemical Co. Submitted to WHO by Bayer/Tomen.
  18. Curren, R.D. (1988) Unscheduled DNA synthesis in rat primary hepatocytes. Unpublished report from
    Microbiological Associates, Inc. Submitted to WHO by Bayer/Tomen.
  19. Cushman, J.R. (1984) Modified Buehler test for the skin sensitization potential of methamidophos.
    Unpublished report from Standard Oil Company of California. Submitted to WHO by Bayer/Tomen.
  20. Derr, R.F. & Draves, K. (1983) Methanethiol metabolism in the rat. Res. Communications Chem.
    Pathol. Pharmacol., 39/3, 503–506.
  21. Easter, M.D. & Rosenberg, D.W. (1986) The cholinesterase inhibition potential of analytical grade
    methamidophos (SX-1672) and methamidophos technical (SX-1490) following topical application of a
    single dose to adult male and female rats. Unpublished report from Chevron Environmental Health
    Center, Inc. Submitted to WHO by Bayer/Tomen.
  22. Eigenberg, D.A., Pazdernik, T.L. & Doull, J. (1983) Haemoperfusion and pharmacokinetic studies with
    methamidophos in the rat. Fundam. Appl. Toxicol., 3, 490–501.
  23. Eigenberg, D.A., Freshwater, K.J. & Lake, S.G. (1998) A two-generation dietary reproduction study in
    rats using technical methamidophos. Unpublished report from Bayer Corp., dated 5 January 1998, file
    No. 8398. Submitted to WHO by Bayer/Tomen.
  24. Eisenlord, G.H. (1984) Dominant lethal study of methamidophos technical in mice. Unpublished report
    from Standard Oil Company of California. Submitted to WHO by Bayer/Tomen.
  25. Ellman, G.L., Courtney, K.D., Andres, V. & Featherstone, R.M. (1961) A new and rapid colorimetric
    determination of acetylcholinesterase activity. Biochem. Pharmacol., 7, 88–95.
  26. El-Sebae, A.H., Ahmed, N.S., EL-Gendy, K.S., EL-Bakary, A.S. & Soliman, S.A. (1987)
    Methamidophos (Tamaron)—A delayed neuropathic compound to man, but negative to chickens. In:
    Proceedings of the Second National Conference on Pests and Diseases in Vegetables and Fruits,
    Ismailia, Abstract No. 15, pp. 474–475.
  27. Esber, H.J. (1983) In vivo cytogenetics study in mice, methamidophos technical (SX 1244).
    Unpublished report from EG&G Mason Research Institute. Submitted to WHO by Bayer/Tomen.
    Fakhr, I.M.I., Abdel-Hamid, F.M. & Afifi, L.M. (1982) In vivo metabolism of 32P-‘Tamaron’ in the rat.
    Isotope Radiat. Res., 14, 49–55.
  28. Flucke, W. (1985) SRA 5172 TA (Tamaron TA)—c.n. methamidophos—Study for acute dermal
    toxicity to the hen (Gallus domesticus). Unpublished report from Bayer AG, dated 17 August 1985, file
    Pesticide residues in food:2002 - METHAMIDOPHOS


Case 10: A Pesticide Suicide Attempt


Case 11: A Pyrethroid Inhalation from a Crop Duster

  1. Bradberry SM, Cage SA, Proudfoot AT, Vale JA. (2005). Poisoning due to pyrethroids. Toxicology Review.  24(2):93-106.
  2. EPA Recognition and Management of Pesticide Poisonings:
    • Chapter 7: Pyrethrum and Pyrethrins
    • Chapter 8: Pyrethroids
  3. Sutton PM, Vergara X, Beckman J, Nicas M, Das R  (2007). Pesticide illness among flight attendants due to aircraft disinsection. American Journal of Industrial Medicine, 50(5):345-56.
  4. Walters JK, Boswell LE, Green MK, Heumann MA, Karam LE, Morrissey BF, Waltz JE (2009). Pyrethrin and pyrethroid illnesses in the Pacific northwest: a five-year review. Public Health Reports,  124(1):149-59.



Taking an Occupational Environmental Health History

  1. Marshall L, et al. (2002) Identifying and Managing Adverse Environmental Health Effects: Taking an Exposure History. Can Med Ass J. 166 (8) 1049-55.
  2. Sanborn, M et al. Identifying and Managing the Adverse Environmental Health Effects: 4 Pesticides. Can Med Ass J. 166 (11) 1431-1436.
  3. Reigart JR, Roberts,JR. (1999) Recognition and Management of Pesticide Poisonings. 5th Ed. Ch 3. Environmental and Occupational History. EPA. p.18-19.
  4. Blue AV et al. (2000). Medical students' abilities to take an occupational history: use of the WHACS mnemonic. J Occup Environ Med. 42(11):1050-3.
  5. Physicians for Social Responsibility (PSR). Pediatric Environmental Health Toolkit
  6. National Environmental Education Foundation (NEETF) Pediatric Environmental History Form.
  7. CDC. Managing Elevated Blood Lead Levels Among Young Children: Table 3.2. Guidelines for Questions to Ask Regarding a Child’s Environmental History
  8. National Environmental Education Foundation (NEETF). Environmental Health History Form for Pediatric Asthma Patient


  • American Association of Poison Control Centers, Annual Reports
  • Canadian Pesticide Literature Review
  • Environmental Working Group
    • Nurses' Health a Survey on Health and Chemical Exposures, (Clinical Environmental Health Assessment, December 2007)
  • US Environmental Protection Agency (EPA)
  • National Institute for Occupational Safety and Health (NIOSH)



This document contains patient education information for health care providers regarding safe use of pesticides.

Last Updated on Wednesday, 04 April 2012 09:22


Pesticides are broadly categorized according to the pest that they are intended to target.  Herbicides are chemicals designed to kill undesirable plants.  Herbicides are used commonly in gardening and lawn care as well as in commercial agriculture. 

Brand names for all pesticides change often so health care providers should be familiar with active ingredients, not just product names.  Herbicides can be formulated from a variety of active ingredients so cases of over-exposure may require different courses of medical treatment.  Health care providers should be aware of these differences and be able to consult the appropriate documentation (the pesticide label and the material safety data sheet for the active ingredient) and a poison control specialist when presented with a case of pesticide poisoning.


Some common active ingredients in herbicides include:

  • Chlorophenoxy herbicides (2-4D and mecoprop are both widely available)
  • Paraquat and diquat
  • Pentachlorophenol and dinitrocresol (wood preservatives)
  • Copper chromium arsenate (Primary source of wood preservative for decks, fences, and children’s wood playground sets – discontinued in 2003.)
  • Glyphosate (active ingredient in Roundup®)






EPA. Types of Pesticides. 2007. Environmental Protection Agency. 21 Feb 2008. <>

NEEF. National Pesticide Competency Guidelines for Medical & Nursing Education. 2003. National Environmental Education Foundation. 14 Nov. 2007 <>

Last Updated on Tuesday, 01 May 2012 20:11

Material Safety Data Sheet (MSDS)

Material Safety Data Sheet

The Occupational Safety and Health Administration requires all employers to provide workers with information about any hazardous chemicals used at the worksite.  The agency's Hazard Communication Standard requires chemical manufacturers to provide customers with detailed information about each chemical's hazardous properties.  This hazard information is provided in the form of a material safety data sheet, or MSDS.  Workers must be adequately trained to use hazardous chemicals and are entitled to access the MSDS for any chemical he/she uses.

Last Updated on Tuesday, 01 May 2012 20:10
  • «
  •  Start 
  •  Prev 
  •  1 
  •  2 
  •  3 
  •  Next 
  •  End 
  • »
Page 1 of 3