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R
ECOGNITION
 
AND
M
ANAGEM ENT
 
OF
P
ESTICIDE
P
OISONINGS
Fifth Edition, 1999
J. Routt Reigart, M.D.
Professor of Pediatrics, Medical University of South Carolina
James R. Roberts, M.D., M.P.H.
 Assistant Professor of Pediatrics, Medical University of South Carolina
Support for this publication was provided by:
Certification and Worker Protection BranchField and External Affairs DivisionOffice of Pesticide ProgramsU.S. Environmental Protection Agency401 M Street SW (7506C)Washington, DC 20460
For additional copies or more information:
Tel: 703-305-7666Fax: 703-308-2962
The manual is available in electronic format on the Internet at:
http://www.epa.gov/pesticides/safety/healthcare
 
Acknowledgments
We are grateful to the Office of Pesticide Programs, Environmental Protection Agency, for giving us theopportunity to collaborate on this new edition. Our thanks go to Kevin Keaney, Acting Branch Chief, forhis support and vision, and for giving this publication priority attention. Particular mention should also bemade of the efforts of Jerome M. Blondell, Ph.D., M.P.H., and Ameesha Mehta, M.P.H., whose oversightand constant assistance were invaluable in moving this project forward. Ana Maria Osorio, M.D., M.P.H.,contributed Chapter 3, Environmental and Occupational History, to this manual.Experts in clinical toxicology conducted critical reviews of draft material. We are greatly appreciativeof the time and effort of the following reviewers:Jeffery Lloyd Burgess, M.D., M.P.H.Assistant ProfessorEnvironmental Occupational Health UnitUniversity of Arizona Prevention CenterMatthew C. Keifer, M.D., M.P.H.Assistant ProfessorDepartment of Medicine/Environmental HealthUniversity of WashingtonWayne R. Snodgrass, M.D., Ph.D.Professor and HeadClinical Pharmacology-ToxicologyTexas Poison CenterSheldon L. Wagner, M.D.Professor of Clinical ToxicologyOregon State UniversityMany other individuals contributed their time and skill to this publication. We are very appreciativeof the tireless efforts of Patricia Clark, our administrative assistant, who spent endless hours in textreview, securing references, communicating with reviewers, and otherwise making the revision processpossible and easier than anticipated. Gilah Langner of Stretton Associates, Inc., provided editorial super-vision. Will Packard and Sarah Carter of Free Hand Press, Inc. were responsible for the format andlayout of the manual.
Cover photographs by Steve Delaney, EPA.
 
Section I: General Information
1Introduction...........................................................................................................22General Principles in the Management of Acute Pesticide Poisonings....................103Environmental and Occupational History..............................................................17
Section II: Insecticides
4Organophosphate Insecticides...............................................................................345N-Methyl Carbamate Insecticides.........................................................................486Solid Organochlorine Insecticides.........................................................................557Biologicals and Insecticides of Biological Origin...................................................638Other Insecticides, Acaricides, and Repellents........................................................74
Section III: Herbicides
9Chlorophenoxy Herbicides...................................................................................9410Pentachlorophenol................................................................................................9911Nitrophenolic and Nitrocresolic Herbicides........................................................10412Paraquat and Diquat............................................................................................10813Other Herbicides................................................................................................118
Section IV: Other Pesticides
14Arsenical Pesticides.............................................................................................12615Fungicides..........................................................................................................13716Fumigants...........................................................................................................15617Rodenticides.......................................................................................................16918Miscellaneous Pesticides, Solvents, and Adjuvants.................................................18319Disinfectants.......................................................................................................196
Section V
Index of Signs and Symptoms......................................................................................210Index of Pesticide Products..........................................................................................223
CONTENTS
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