INTRODUCTION: Pesticides are the second major cause of poisoning in Brazil, but information about the chemicals involved and the clinical management of patients is scarce. METHODS: This study is a retrospective review of 709 pesticide cases reported to a toxicological information center from 2004 to 2007. RESULTS: Over 90% of the cases occurred after accidental or self-poisoning; more than 60% of the accidents involved children up to 4 years old, mainly with domestic pyrethroid insecticides. One hundred ninety-four cases involved chumbinho, an illegal rodenticide known to contain acetylcholinesterase inhibitor insecticides, mainly aldicarb. In about half the cases, the individuals were admitted to hospitals. Those poisoned with acetylcholinesterase inhibitors stayed longer and most of them displayed pronounced clinical signs of poisoning (Poisoning Severity Score grades 2-4); 14 of the 18 deaths reported occurred with these products. Atropine was given to about 30% of the individuals, including to some with no cholinergic symptoms or exposed to non-acetylcholinesterase inhibitors. All 81 poisonings with coumarin were asymptomatic, but in half of the cases the individuals received vitamin K. CONCLUSIONS: The lack of laboratory support to confirm the chemical involved in the poisonings certainly contributed to the unnecessary antidote administration. In spite of continuing government efforts, poisoning with chumbinho is still a major problem in the country.
INTRODUCTION: Pesticides are the second major cause of poisoning in Brazil, but information about the chemicals involved and the clinical management of patients is scarce. METHODS: This study is a retrospective review of 709 pesticide cases reported to a toxicological information center from 2004 to 2007. RESULTS: Over 90% of the cases occurred after accidental or self-poisoning; more than 60% of the accidents involved children up to 4 years old, mainly with domestic pyrethroid insecticides. One hundred ninety-four cases involved chumbinho, an illegal rodenticide known to contain acetylcholinesterase inhibitor insecticides, mainly aldicarb. In about half the cases, the individuals were admitted to hospitals. Those poisoned with acetylcholinesterase inhibitors stayed longer and most of them displayed pronounced clinical signs of poisoning (Poisoning Severity Score grades 2-4); 14 of the 18 deaths reported occurred with these products. Atropine was given to about 30% of the individuals, including to some with no cholinergic symptoms or exposed to non-acetylcholinesterase inhibitors. All 81 poisonings with coumarin were asymptomatic, but in half of the cases the individuals received vitamin K. CONCLUSIONS: The lack of laboratory support to confirm the chemical involved in the poisonings certainly contributed to the unnecessary antidote administration. In spite of continuing government efforts, poisoning with chumbinho is still a major problem in the country.