You are on page 1of 27

Agricultural chemicals

chemicals toxicity, symptoms, and signs

Insecticides

organophosphates (e.g., malathion,


parasympathetic excess
parathion)

carbamates (e.g., carbaryl, carbofuran) parasympathetic excess

chlorinated hydrocarbons

DDT, methoxychlor CNS stimulation, convulsions, nausea, vomiting

chlordecone (Kepone) nausea, vomiting

insecticides from plants

pyrethrins allergic contact dermatitis, asthma, CNS stimulation

irritation of skin, eyes, and lung; mild CNS stimulation; breast


rotenone
tumours in rats

Herbicides

chlorophenoxyacetic acids

nausea, vomiting, fatigue, diarrhea, muscle ache and twitches,


2,4-dichlorophenoxy-acetic acid (2,4-D) peripheral nerve damage, convulsion, memory loss, colour visual
disorder

2,4,5-trichlorophenoxy-acetic acid (2,4,5-


irritation to skin, eyes, and nose; teratogenic in animals
T)

bipyridinium compounds

paraquat lung fibrosis; kidney and liver damage

diquat nosebleed, cough, fever, jaundice

others (e.g., diuron, monuron, atrazine,


irritation to the skin, nose, and throat
simazine, chlorpropham, alachlor)

Fungicides

irritating to eyes, nose, and throat; anorexia; weakness; shortness


pentachlorophenol
of breath; chest pain; carcinogenic in animals

creosote extremely irritating to skin, eyes, nose, and throat

moderate irritation to eyes, nose, and throat; mild skin irritation;


ferbam, thiram
allergic contact dermatitis
Agricultural chemicals

Fumigant nematocides

mildly irritating to skin, eyes, and nose; testicular damage;


1,2-dibromo-3-chloropropane (DBCP)
carcinogenic in animals

severe irritation to skin, eyes, and throat; headache; anorexia;


ethylene dibromide
CNS depression; carcinogenic in animals

headache, nausea, vomiting, drowsiness, emotional disturbances,


methyl bromide tremors, convulsion, coma, lung irritation, bronchial
inflammation

Rodenticides

warfarin internal bleeding

restlessness, increased audio and visual sensitivities, muscular


strychnine
stiffness in face and legs followed by convulsion

hair loss; skin eruptions; intestinal bleeding; anorexia; nausea;


thallium
vomiting; injuries of peripheral nerves, liver, and kidney

Plant growth regulators

daminozide (Alar) carcinogenic in animals

Industrial chemicals

chemicals toxicity, symptoms, and signs

Hydrocarbons

gasoline, toluene, xylene, hexanes, n- CNS depression, headache, nausea, vomiting, irritation of skin and
hexane, heptanes eyes

Chlorinated hydrocarbons

chloroform, carbon tetrachloride, CNS depression, sensitization of heart muscle; many cause liver and
methylene chloride, and others kidney injuries; some cause liver tumours in animals

Alcohols

headache; nausea; vomiting; diarrhea; abdominal pain; restlessness;


methanol cold, clammy limbs; shortness of breath; CNS depression; blurred
vision; blindness

ethanol irritation of stomach, CNS depression, fetal alcohol syndrome; brain


Industrial chemicals

damage, amnesia, sleep disturbances, heart damage, fatty liver, liver


cirrhosis

Aldehydes

irritation of eyes, nose, and throat; headache; bronchitis; lung edema;


formaldehyde
asthma and allergic contact dermatitis; carcinogenic in animals

Ketones

various irritation of eyes, nose, and throat

Esters

various irritation of eyes, nose, and throat; pulmonary edema

Aromatic amines and nitro compounds

various CNS depression, methemoglobinemia; some are carcinogenic

Anhydrides and isocyanates

irritation of skin, eyes, nose, and throat; asthma; allergic contact


various
dermatitis

Miscellaneous organic compounds

polychlorinated biphenyls (PCB),


polybrominated biphenyls (PBB), chloracne, liver injury; carcinogenic and teratogenic in animals
tetrachlorodibenzodioxin (TCDD)

Metals

colic; abnormal red blood cells; injuries to kidney, peripheral nerves


(weakness and palsy), and brain (irritability, restlessness,
lead compounds
excitement, confusion, delirium, vomiting, visual disturbance); lead
acetate is carcinogenic in rats

edema, heart damage, low blood pressure, vomiting of blood, bloody


arsenic compounds stool, skin lesions, injuries of nervous systems, liver and kidney
damage, cancers of skin and lung

Corrosives (acids and alkalies)

corrosion of skin, mouth, throat, stomach, and intestine on contact;


various
irritation of eyes, nose, and throat if inhaled

Miscellaneous inorganic compounds

hydrogen cyanide, potassium cyanide, drowsiness, dizziness, headache, rapid breathing, palpitations,
sodium cyanide weakness, muscle twitches, cyanosis, coma, convulsion
Industrial chemicals

irritating to skin, eyes, nose, throat, and lung; chest pain; lung
hydrogen sulfide, chlorine edema; shortness of breath; pneumonia; headache; dizziness; nausea;
vomiting

irritations of mouth, stomach, and intestine; CNS depression; tooth


sodium fluoride, stannous fluoride
mottling; increased bone density

irritation or corrosion of esophagus, stomach, and intestine; irritation


bleaches (sodium hypochlorite, calcium
of eyes and skin; acidic condition in the body; rapid breathing;
hypochlorite)
aspiration-induced lung inflammation

lung fibrosis; shortness of breath; cough; chest pain; cancers of the


silica dust, asbestos fibres
lung, linings of the lung and abdomen, and intestine (asbestos)

Air pollutants

irritation of eyes, nose, throat, and lung; nausea and vomiting;


sulfur dioxide shortness of breath; alterations in sense of smell and taste;
unconsciousness

irritation of eyes, nose, throat, and lung (dry throat with ozone);
shortness of breath; bluish pale appearance; rapid breathing and
nitrogen oxides, ozone
pulse; pneumonia; nitrogen oxides also cause the destruction of red
blood cells and cause liver and kidney damage

weakness, confusion, headache, nausea and vomiting, dizziness,


carbon monoxide drowsiness, jaw stiffness, shortness of breath, seizures, coma, lung
edema, pneumonia

Drugs and health care products

drugs toxicity, symptoms, and signs

Painkillers

increased perspiration, respiration increased initially, dehydration, acidity in the body,


aspirin, sodium
hypoglycemia, CNS depression, respiration decreased, nausea, vomiting, diarrhea,
salicylate
confusion, coma, convulsion, lung edema, death

acetaminophen skin rash, decreases in blood cells, liver and kidney injuries, hypoglycemia, coma

nausea, vomiting, pinpoint pupil, depressed respiration, delusions, confusion, muscle


morphine
flaccidity, constipation, coma, death

Tranquilizers and
Drugs and health care products

sleeping pills

increased salivation, muscular incoordination, slurred speech, weakness, seizures,


benzodiazepines
irritability, loss of appetite

slowed respiration, CNS depression, depressed heartbeat, low blood pressure, shock,
barbiturates kidney failure, lung edema, pneumonia, muscular incoordination, slurred speech,
pinpoint pupil, coma, death

Antipsychotic drugs

sympathetic blockade reflex increase in heart rate, parasympathetic blockade, tremors,


various
rigidity, restlessness, jaundice

Nasal decongestants

various nervousness, dizziness, tremor, confusion, increased blood pressure and heart rate

Antihistamines

drowsiness, dizziness, ear ringing, blurred vision, lack of coordination, headache,


various nausea, vomiting, loss of appetite, heartburn, dry mouth and throat, cough,
palpitations, decrease in blood pressure, chest tightness, tingling of the hands

Cough medicine

various CNS depression

Antiseptics

various irritation of esophagus and stomach when ingested

Vitamins and iron pills

fatigue, dizziness, severe headache, vomiting, edema, dry and peeling skin, enlarged
vitamin A
liver and spleen, teratogenic, red skin eruptions, abnormal hair growth

nausea, upper abdominal pain, diarrhea, bloody or brown vomit, dehydration, intestinal
iron bleeding, liver damage, drowsiness, acidic condition in the body, rapid breathing,
shock

Antidepressants

tricyclic antidepressants parasympathetic blockade, CNS damage, cardiovascular system damage

thyroid enlargement, edema, increased urination, abnormal heart rhythm, vomiting,


lithium salts
diarrhea, tremor, muscle flaccidity, seizures, coma

Drugs of abuse

various primarily CNS effects


Drugs and health care products

Cardiovascular drugs

digitalis (e.g., digoxin, gastrointestinal irritation, abdominal discomfort, salivation, fatigue, facial pain, visual
digitoxin) disturbances, confusion, delirium, hallucinations

beta blockers (e.g., constriction of bronchi, nausea, vomiting, diarrhea, constipation, headache, insomnia,
propanolol, metoprolol) dizziness, abnormal heart rhythm

headache, dizziness, gastrointestinal symptoms, edema, rash, abnormal heart rhythm,


verapamil
lowered blood pressure

anorexia, nausea, vomiting, confusion, delirium, psychotic behaviour, abnormal heart


procainamide, quinidine
rhythm, lowered blood pressure

Therapeutics for asthma

various CNS stimulation

Representative toxic microfungi

toxin comments

causes
poisoning in
animals and
humans;
ergotoxine, a
produces
complex of toxic
vomiting,
alkaloids,
abdominal
Claviceps purpurea (ergot) ergocryptine,
pain,
ergocornine,
numbness,
ergocristine, and
nervous
others
disorders,
convulsions,
gangrene, and
abortion

Stachybotrys chartarum stachybotryotoxin causes a


toxicosis in
animals and
humans;
produces
stomatitis
(inflammatory
disease of the
mouth),
rhinitis
(inflammation
of the mucous
membranes of
Representative toxic microfungi

the nose),
conjunctivitis
(inflammation
of the inner
surface of the
eyelid),
failure of
blood to clot,
blood
abnormalities,
neurological
disturbances,
and death

causes
toxicosis in
animals and
possibly
humans;
toxins damage
aflatoxin complex
liver and
Aspergillus flavus and other species, Penicillium species (16 or more known
kidneys;
toxins)
aflatoxin is
one of the
most potent
liver-cancer-
producing
agents known

causes
alimentary
toxic aleukia
in animals
and humans;
produces
burning
sensation of
the mouth,
tongue, throat,
fusariogenin, and stomach;
Fusarium sporotrichioides and other Fusarium species epicladosporic acid, causes
fagicladosporic acid nausea,
vomiting,
headache,
cold
extremities,
hemorrhagic
spots,
convulsions,
anemia,
gangrene,
death
Representative toxic microfungi

same
Cladosporium epiphyllum and other species of Cladosporium
as Fusarium species

causes facial
eczema (an
eruptive
severe rash)
in cattle;
produces
sensitization
of the skin to
Pithomyces chartarum (Sporidesmium bakeri) sporidesmin
sunlight,
resulting in
scab
formation and
sores; there
may also be
severe liver
damage

causes moldy
or yellowed
rice, which is
toxic to
animals and
humans; the
effects in
humans have
luteoskyrin,
not been well
islanditoxin,
defined; may
citrinin,
Fusarium species, Rhizopus species, Aspergillu cause nausea,
citreoviridin, and
s species, Penicillium islandicum, and others vomiting,
others; a large
diarrhea,
complex of poisons
prostration,
is involved
liver damage,
and death; the
effects vary
greatly
because of the
various
poisons
involved
Representative poisonous mushrooms

toxin type of poisoning

toxicity to people is variable; causes severe liver damage accompanied


lorchel, or false morel
gyromitrin by nausea, vomiting, abdominal pain, jaundice, enlarged and tender liver,
(Gyromitra esculenta)
coma, convulsions; fatality rate about 15 percent

fly mushroom, or fly symptoms develop rapidly and are severe, consisting of severe
agaric (Amanita muscarine gastrointestinal disturbances, delirium, hallucinations, convulsions; rarely
muscaria) causes death

symptoms develop slowly, about 6–15 hours after eating: extreme


abdominal pain, nausea, vomiting, excessive thirst, anuria (absence or
death cap (Amanita amanitine,
defective excretion of urine), prostration, weakness, jaundice, cyanosis,
phalloides) phalloidine
convulsion, death; fatality rate about 50 percent; no known antidote but
some treatment available

jack-o'-lantern
fungus (Omphalotus muscarine causes gastrointestinal upset, not fatal
olearius)

some people experience a peculiar type of intoxication after eating this


mushroom and then drinking an alcoholic beverage: giddiness,
inky cap (Coprinus
unknown gastrointestinal upset, prostration, and tachycardia (rapid heart action);
atramentarius)
the alcohol is believed to increase the solubility and absorption of the
poison

Entoloma sinuatum unknown causes gastrointestinal upset, usually not fatal

Inocybe patouillardii muscarine symptoms are similar to A. muscaria poisoning

Lepiota morgani unknown causes gastrointestinal upset; fatalities have been reported

Mexican
hallucinogenic psilocybin,
causes euphoria, loss of sense of distance and size, and hallucinations
mushroom (Psilocybe psilocin
mexicana)
Representative poisonous plants

name and distribution toxic principle toxic effects and comments

Plants poisonous to eat

onset of symptoms may be delayed several hours to


rosary pea, or jequirity bean abrin (N-
two days: vomiting, diarrhea, acute gastroenteritis,
(Abrus precatorius); tropical methyltryptophan) and
chills, convulsions, death from heart failure; one
regions abric acid
seed chewed may be fatal to a child

tingling, burning sensation in tongue, throat, skin;


aconite, or monkshood
aconite and a complex of restlessness, respiratory distress, muscular
(Aconitum napellus); North
other alkaloids uncoordination, vomiting, diarrhea, convulsions,
America, Europe
possible death; an extremely poisonous plant

dizziness, diarrhea, respiratory distress, vomiting,


headache, sharp pains in spine, coma, death;
corn cockle (Agrostemma frequent ingestion of small amounts results in
githagin, agrostemmic
githago); North America, chronic githagism (a disease, similar to lathyrism,
acid (saponins)
Europe that results in pain, burning and prickling sensations
in lower extremities, and increasing paralysis);
milled seeds may be found in wheat flour

dullness, weakness, irregular behaviour, impaired


locoweed (Astragalus species); vision, edema of eyelids, loss of muscular control,
locoine
Northern Hemisphere loss of appetite, emaciation, starvation, death in
sheep, horses, and cattle

dryness of the skin, mouth, throat; difficulty in


swallowing, flushing of the face, cyanosis (a bluish
belladonna (Atropa hyoscyamine, atropine,
discoloration of skin due to insufficient oxygen),
belladonna); United States, hyoscine, and a complex
nausea, vomiting, slurred speech, coma, death;
Europe, Asia of other alkaloids
children and animals frequently poisoned by eating
fruit

sudden vomiting, drowsiness, muscular and


akee (Blighia sapida) hypoglycin A, B
nervous exhaustion, prostration, coma, death

glycosides pulmonary emphysema, respiratory distress,


rape (Brassica napus)
(isothiocyanates) anemia, constipation, irritability, blindness in cattle

exaltation, inebriety, confusion, followed by central


marijuana (Cannabis sativa); nervous system depression; prolonged, frequent use
cannabinol, canabidiol,
United States, Mexico, tropical may produce dullness or mania; ingestion in large
and related compounds
America quantities or injection of the purified extract may
produce death by cardiac depression

water hemlock (Cicuta abdominal pain, nausea, vomiting, diarrhea,


maculata); northern cicutoxin respiratory distress, hypersalivation, convulsions,
temperate regions death; among the most poisonous plants

poison hemlock (Conium coniine, conhydrine, N- muscular weakness, paralysis of extremities,


maculatum); temperate United methyleoniine, coniceine, blindness, respiratory paralysis, death; responsible
Representative poisonous plants

States, South America, for many human fatalities; leaves most toxic when
and other alkaloids
northern Africa, Asia plant is flowering

purging croton (Croton vomiting, violent purging, collapse, death; croton


croton, croton resin,
tiglium); Asia, Pacific Islands, oil is also a skin irritant, causing reddening,
ricinine
Africa swelling, and pustules

glycoside involving vomiting, burning sensation of the mouth,


daphne (Daphne mezereum);
aglycone ulceration of the oral mucosa, diarrhea, stupor,
temperate regions
dihydroxycoumarin weakness, convulsions, and death

headache, nausea, vomiting, dizziness, thirst, dry


jimsonweed or thornapple and burning sensation in skin, mental confusion,
hyoscine, hyoscyamine,
(Datura stramonium); mania, loss of memory, convulsions, death;
atropine
temperate and tropical regions children are often poisoned by eating seeds or
sucking flowers

delphinine,
burning and inflammation of mouth, nausea,
larkspur (Delphinium species); delphinoidine,
vomiting, respiratory distress, itching, cyanosis; one
northern temperate regions delphisine, and other
of the greatest causes of death in grazing livestock
alkaloids

dumbcane (Dieffenbachia
irritation and burning of the mouth, tongue, and
seguine); widely cultivated in protoanemonine, calcium
lips; hypersalivation, swelling of the tongue,
temperate regions, tropical oxalate
difficulty in swallowing and breathing
regions

loss of appetite, nausea, vomiting, slow pulse and


foxglove (Digitalis purpurea); glycosides, digitoxigenin,
irregular heartbeat, diarrhea, abdominal pain,
Europe, North America and others
headache, fatigue, drowsiness, convulsions, death

discomfort, then burning of the throat, giddiness,


vomiting of blood, respiratory distress, drowsiness,
wild yam (Dioscorea hispida);
dioscorine exhaustion, paralysis of the nervous system, death;
southern Asia, Pacific Islands
raw tubers are a frequent cause of death in the
Philippines

central nervous system stimulation followed by


Huanuco cocaine depression, numbness of tongue, paralysis of
cocaine and other
(Erythroxylon coca); tropics of respiratory centres, cyanosis, respiratory distress,
alkaloids
both hemispheres death; leaves are commonly chewed by Indians of
Peru and Bolivia as a stimulant

manchineel (Hippomane fruit causes gastroenteritis, which may be fatal, and


physostigmine or a
mancinella); Florida, Central causes ulceration of intestinal tract; sap causes
similar alkaloid plus a
America, South America, burning of skin, swelling and hemorrhage of the
sapogenin
West Indies eyes; sap is used as an arrow poison

black henbane (Hyoscyamus hyoscyamine, hyoscine, similar to belladonna poisoning caused by Atropa
niger); North America, atropine, and other belladonna; children are poisoned by eating seeds
Europe, Asia, Oceania alkaloids and pods
Representative poisonous plants

burning of the throat, bloating, dizziness, vomiting,


Barbados nut (Jatropha
curcin diarrhea, drowsiness, dysuria, leg cramps, violent
curcas); tropics
purgative action; may be fatal to children

hypersalivation, tears, impaired vision, tingling of


mountain laurel (Kalmia skin, dizziness, vomiting, muscular paralysis,
andromedotoxin
latifolia); North America convulsions, coma, death; children are poisoned by
eating leaves

grass pea (Lathyrus sativus);


back pain, weakness in legs, paralysis; has caused
North America, Europe, beta-aminopropionitrile
death in children
northern Africa, Asia

cassava (Manihot esculenta); nausea, respiratory distress, twitching, staggering,


cyanophoric glycosides
tropics convulsions, coma, death

chinaberry (Melia azedarach);


stomatitis with violent and bloody vomiting,
North America, southern azadarin
paralysis
Africa, Asia

opium poppy (Papaver morphine, codeine,


central nervous system depression, pinpoint pupils,
somniferum); Europe, Asia, thebaine, papavarine,
depressed respiration, cyanosis, coma, death
tropics narcotine

pokeberry (Phytolacca
burning, bitterness in mouth, vomiting, purging,
americana); North America, phytolaccine
spasms, convulsions, death
Europe, southern Africa

burning of mouth, throat, and stomach, vomiting,


castor bean (Ricinus
diarrhea, abdominal cramps, dulled vision,
communis); United States, ricin, a toxalbumin
convulsions, respiratory distress, paralysis, death;
tropics
one to three seeds may be fatal to children

black nightshade (Solanum


nausea, vomiting, abdominal pain, diarrhea,
nigrum); North America, solanine, a glycoalkaloid
trembling, paralysis, coma, death
Europe

Plants poisonous by contact

eye irritation, blindness, blistering of the skin,


euphorbia, spurge a complex of substances
swelling around the mouth, burning of the mouth,
(Euphorbia species); including alkaloids,
unconsciousness, death; milky sap is used as an
worldwide glycosides, and others
arrow poison

contact produces instant, intense stinging and


itching due to an irritating substance injected into
the skin by the stinging hairs; results in a skin
spurge nettle (Jatropha urens);
toxin unknown eruption of minute red papular (small conical
North America, Europe, Asia
elevations of the skin) rash, which lasts about 30
minutes; a dull purplish discoloration of the skin
may remain for several weeks
Representative poisonous plants

contact with the stinging hairs of this plant


produces intense, rapidly spreading pain, reddened
shiney-leaf stinging tree, tree 5-hydroxytryptamine
rash, and later a severe skin eruption; severe stings
nettle (Dendrocnide (and other toxic
may result in intense, unbearable pain; fatalities
photiniphylla); Australia substances?)
have been reported; dried leaves may cause intense
sneezing

contact with any part of the tree, especially sap,


poisonwood (Metopium
turns the skin black, causes a rash, blisters, etc.;
toxiferum); West Indies, similar to poison ivy
smoke from a burning tree is very irritating, causing
Florida
illness and temporary blindness

strophanthus an alkaloid, trigonelline,


vomiting, slow and irregular pulse, blurred vision,
(Strophanthus species); and a large number of
delirium, circulatory failure, death; used as an
Florida, tropical America, cardiac glycosides and
arrow poison
Africa aglycones

haziness of vision, relaxation of facial muscles,


curare (Strychnos toxifera);
toxiferines, caracurines, inability to raise head, loss of muscle control of
Central America and northern
and other alkaloids arms, legs, and respiratory muscles, death; used as a
South America
poison for arrows and for blowgun darts

poison ivy (Toxicodendron


skin irritation, swelling, blistering, itching; may be
radicans, also called Rhus
urushiol fatal to young children; smoke from burning plant
toxicodendron); North
is toxic
America

Plants that produce photosensitization

ingestion of the leaves by animals causes liver


dysfunction, thereby resulting in deposition of a
buckwheat (Fagopyrum fagopyrin, a
photosensitizing pigment in the skin; sunlight then
sagittatum); North America, naphthodianthrone
causes redness of the skin, nervousness, swelling of
Europe derivative
the eyelids, convulsions, and prostration in farm
animals

St. Johnswort (Hypericum hypericin, a


perforatum); North America, naphthodianthrone similar to buckwheat
Europe derivative

Plants that produce airborne allergies

hay fever (respiratory allergy), may also cause an


box elder (Acer negundo); oleoresin and a water-
eczematous dermatitis of the exposed parts of the
Northern Hemisphere soluble antigen
body
Representative crinotoxic animals*

*Animals in which poison glands are present and poison is released into the environment through a pore.
**Poisonous amphibians are sometimes referred to as "venomous," but they do not possess a true venom apparatus.
They possess only poison glands.

name and distribution toxic principle toxic effects and comments

Sponges

contact with the sponge produces a


chemical irritation of the skin,
red moss (Microciona prolifera); eastern
unknown redness, stiffness of the finger
United States coastal waters
joints, swelling, blisters, and
pustules

Flatworms

poison is produced by epidermal


skin glands; no human
flatworm (Leptoplana tremellaris); European intoxications recorded; extracts
unknown
coastal waters from the skin of these worms
injected into laboratory animals
produces cardiac arrest

Arthropods—joint-legged animals

toxic substance does not seem to be


produced by special glands but is
found throughout the body of the
beetle; no discomfort at time of
initial contact; after about 8–10
hours large blisters develop on the
skin accompanied by slight burning
blister beetles (Cantharis vesicatoria); United or tingling sensation; swallowing
cantharidin
States of the beetles may cause kidney
damage; cantharidin is used as an
aphrodisiac known as Spanish fly
—a very dangerous substance to
use; ingestion can cause severe
gastroenteritis, kidney damage,
blood in the urine, priapism,
profound collapse, and death

repugnatorial (distasteful to
enemies) fluid may be exuded or
forcefully squirted from body pores
a distance up to 30 inches or more;
millipedes (species of Orthoporus,
contact with the skin causes mild to
Rhinocrichus, Julus, and Spirobolus); unknown
moderately intense burning pain,
temperate and tropical regions
redness, and pigmentation of the
skin; toxic fluid squirted in the eyes
may cause temporary blindness, an
inflammatory reaction, and pain
Representative crinotoxic animals*

tick bites result in swelling,


venomous ticks (species
redness, intense pain, headache,
of Ixodes and Ornithodoros); temperate and unknown
muscle cramps, loss of memory,
tropical regions
etc.

Fishes

sea lamprey (Petromyzon marinus); Atlantic slime of the lamprey is toxic;


unknown
Ocean ingestion may cause diarrhea

soapfish (Rypticus saponaceus); tropical and slime of fish is toxic; produces an


neurotoxic
subtropical Atlantic irritation of the mucous membrane

Amphibians**

skin glands of the


salamander are poisonous; effects on humans not known;
contains the alkaloids affects the heart and nervous
fire salamander (Salamandra salamandra);
samandarine, system; causes in animals
Europe
samandenone, samandine, convulsions, cardiac irregularity,
samanine, samandarone, paralysis, and death
samandaridine, and others

produces a poisonous secretion in


the parotid glands and skin;
bufotoxin, bufogenins, and handling of some toads may cause
toads (Bufo species); temperate and tropical 5-hydroxytryplanime; a skin irritation; ingestion causes
regions poison includes a complex nausea, vomiting, numbness of the
of many substances mouth and tongue, and tightness of
the chest; the poison has a digitalis-
like action

skin secretions are


frogs (some species poisonous; histamine,
skin secretions produce a burning
of Dendrobates, Physalaemus, and Rana); bufotenine, physalaemin,
sensation when handled; used by
northern South America and Central serotonin, and other
Indians as an arrow poison
America substances; composition
varies with the species

some frog species produce a


skin secretions are burning sensation and a skin rash
poisonous; batrachotoxin, when handled; skin secretions in
tree frogs (some species steroidal alkaloids, the eye may produce a severe
of Hyla and Phyllobates); northern South serotonin, histamine, and inflammatory reaction; if ingested,
America, Central America other substances; poison causes vomiting and
bufotenine varies with the abdominal pain; batrachotoxin is
species extremely toxic if injected; used by
Indians as an arrow poison

Representative venomous animals that inflict a sting

name and distribution toxic principle toxic effects and comments


Representative crinotoxic animals*

Cnidarians

immediate, intense stinging,


throbbing, or burning sensation,
Portuguese man-of-war (Physalia species); tetramine, 5-
shooting sensation, inflammatory
tropical seas hydroxytryptamine
rash, blistering of the skin, shock,
collapse, in very rare cases death

immediate, extremely painful


stinging sensation, seared reddened
lines wherever the tentacles touch
sea wasp (Chironex fleckeri); northern and the skin, large indurated wheallike
cardiotoxin
northeast Australia lesions, prostration, dizziness,
circulatory failure, respiratory
distress, rapid death in a high
percentage of cases

burning, stinging sensation,


itching, swelling, redness,
sea anemone (Actinia equina);
nature of venom unknown ulceration, nausea, vomiting,
Mediterranean, Black Sea, etc.
prostration; no specific antidote
available

Mollusks

blanching at the site of injection,


cyanosis of the surrounding area,
numbness, stinging or burning
cone shell (Conus species); tropical Indo- quaternary ammonium sensation, blurring of vision, loss
Pacific region compounds and others of speech, difficulty in swallowing,
nausea, extreme weakness, coma,
and death in some cases; no
specific antidote

sharp burning pain, similar to a bee


sting, numbness of the mouth and
tongue, blurring of vision, loss of
spotted octopus (Octopus maculosus); Indo- cephalotoxin, a tactile sensation, difficulty in
Pacific, Indian Ocean neuromuscular poison speech and swallowing, paralysis
of legs, nausea, prostration, coma,
and death in a high percentage of
cases

Arthropods

bite usually painless; later itching,


edema about the bite, nausea,
kissing bug (Triatoma species); Latin palpitation, redness; the bite is of
unknown
America, United States relatively minor importance but
spreads Chagas disease caused by a
trypanosome (protozoan)
Representative crinotoxic animals*

stinging hairs of the caterpillar


associated with poison-secreting
glands; contact with the hairs
puss caterpillar (Megalopyge species); produces an intense burning pain,
unknown
United States, Latin America itching, pustules, redness, nausea,
fever, numbness, swelling, and
paralysis; recovery usually within
about six days

sting produces acute local pain or


burning sensation, blanching at the
site of the sting surrounded by a
zone of redness, and itching; local
symptoms usually disappear after
24 hours; severe cases may develop
neurotoxin, hemolytic,
massive swelling, redness, shock,
melittin, hyaluronidase,
honeybee (Apis species); worldwide prostration, vomiting, rapid
phospholipase A,
heartbeat, respiratory distress,
histamine, and others
trembling, coma, and death; it is
estimated that 500 stings delivered
in a short period of time can
provide a lethal dose to a human;
bees kill more people in the United
States than do venomous reptiles

stings are similar to honeybee


bumblebee (Bombus species); temperate similar to honeybee (Apis)
(Apis) stings; bumblebees are not
regions venom
as vicious as honeybees

they can both bite and sting; the


sting is similar to that of the
yellow jacket, hornet (Vespula species); similar to bee venom; also
honeybee's but more painful;
temperate regions acetylcholine
yellow jackets are quite aggressive;
stings may be fatal

wasps are less aggressive than


hornets, and their sting is similar to
wasp (Polistes species and Vespa species); similar to bee venom; also
the honeybee's but generally less
worldwide acetylcholine
painful than the hornet's; stings
may be fatal

ant stings cause immediate intense


burning, pain, blanched area at site
bradykinin, formic acid, of sting surrounded by redness,
harvester ant (Pogonomyrmex species); hyaluronidase, hemolytic, ulceration, fever, blistering,
United States phospholipase A, and itching, hemorrhaging into the skin,
others eczematoid dermatitis, pustules,
respiratory distress, prostration,
coma, and death in some instances

fire ant (Solenopsis species); United States, similar to harvester-ant similar to above; stings are very
Latin America venom painful, burning sensation, etc.
Representative crinotoxic animals*

toxic liquid or gas from lateral


glands causes inflammation,
millipede (Apheloria species and others); hydrogen cyanide and swelling, and blindness in contact
temperate areas benzaldehyde with eyes, and brown stain,
redness, swelling, and vesicle
formation in contact with skin

centipede (Scolopendra species); temperate hemolytic phospholipase local pain, swelling, and redness at
and tropical regions and serotonin bite site

bite causes stinging sensation or


burning pain, blanching at site of
bite surrounded by redness,
brown spider (Loxosceles species); United cytotoxic, hyaluronidase, blistering, hemorrhages into the
States, South America, Europe, Asia hemolytic, and others skin and internal organs, ulceration,
vomiting, fever, cardiovascular
collapse, convulsions, sometimes
death

bite may or may not be painful, two


tiny red dots at site of bite,
localized swelling after a few
minutes; intense cramping pain of
abdomen, legs, chest, back; rigidity
of muscles lasting 12–48 hours,
black widow (Latrodectus species); tropical
neurotoxic nausea, sweating, respiratory
and temperate regions
distress, priapism (abnormal,
painful erection of the penis) in
males, chills, skin rash,
restlessness, fever, numbness,
tingling; about 4 percent are fatal;
antiserum is available

most of the large tarantulas found


in the United States, Mexico, and
Central America are harmless to
tarantula (Dugesiella and Lycosa species);
venom varies, usually mild humans; some of the large tropical
temperate and tropical regions
species may be more poisonous,
but their effects are largely
localized

scorpion (species neurotoxin, cardiotoxin, symptoms vary depending upon the


of Centruroides, Tityus, and Leiurus); warm hemolytic, lecithinase, species of scorpion; sting from the
temperate and tropical regions hyaluronidase, and others tail stinger causes a sharp burning
sensation, swelling, sweating,
restlessness, salivation, confusion,
vomiting, abdominal pain, chest
pain, numbness, muscular
twitching, respiratory distress,
convulsions, death; the mortality
rate from stings from certain
species of scorpions is very high;
Representative crinotoxic animals*

antiserum is available

Echinoderms

penetration of the spines produces


crown-of-thorns starfish (Acanthaster
nature of poison unknown a painful wound, redness, swelling,
planci); Indo-Pacific
vomiting, numbness, and paralysis

penetration of the spines produces


long-spined sea urchin (Diadema setosum); an immediate and intense burning
nature of poison unknown
Indo-Pacific sensation, redness, swelling,
numbness, muscular paralysis

bites from the stinging jaws or


pedicellariae (small pincerlike
organs) produce an immediate,
sea urchin (Toxopneustes pileolus); Indo-
nature of poison unknown intense, radiating pain, faintness,
Pacific
numbness, muscular paralysis,
respiratory distress, and
occasionally death

Sharks and rays

penetration of the tail spines


inflicts jagged painful wounds that
produce sharp, shooting, throbbing
pain, fall in blood pressure, nausea,
stingray venom,
stingray (Dasyatis species); warm temperate vomiting, cardiac failure, muscular
cardiotoxin, chemistry
and tropical seas paralysis, rarely death; no known
unknown
antidote; stingrays are among the
most common causes of
envenomations in the marine
environment

Bony fishes

opercular and dorsal fin spines can


produce instant pain, burning,
stabbing or crushing sensation;
pain spreads and becomes
progressively more intense,
weever fish (Trachinus draco); weever fish venom, causing the victim to scream with
Mediterranean Sea chemistry unknown anguish and suffer loss of
consciousness, numbness about the
wound, swelling, redness, nausea,
delirium, difficulty in breathing,
convulsions, and death; no known
antidote

scorpion fish (Scorpaena species); temperate scorpion fish venom, fin spines can inflict painful stings
and tropical seas chemistry unknown and intense, immediate pain that
may cause victim to scream
Representative crinotoxic animals*

followed by redness, swelling, loss


of consciousness, ulceration of the
wound, paralysis, cardiac failure,
delirium, convulsions, nausea,
prostration, and respiratory
distress, but rarely death; no known
antidote

produces an extremely painful sting


stonefish (Synanceja species); Indo-Pacific stonefish venom, by means of the dorsal fin spines;
region chemistry unknown symptoms similar to other scorpion
fish stings but more serious

Reptiles

all of the teeth are venomous; bite


causes local pain, swelling,
Gila monster (Heloderma suspectum); heloderma venom, weakness, ringing of the ears,
southwestern United States primarily a neurotoxin nausea, respiratory distress, cardiac
failure; may cause death; no
antiserum available

Representative animals poisonous when eaten

*Fish poisoning is categorically referred to as "ichthyosarcotoxism," but there are several different forms of fish
poisoning, such as ciguatera fish poisoning, clupeotoxism, scombrotoxism, and others.
**More than 400 species of tropical reef fishes have been involved in ciguatera fish poisoning. These fish are
normally edible but under certain conditions may become toxic.

name and distribution toxic principle toxic effects and comments

Protozoans—one-celled animals

dinoflagellate irritation of mucous membranes of nose and


(Gymnodinium breve); throat; causes sneezing, coughing, respiratory
unknown
Gulf of Mexico, distress due to inhalation of windblown spray
Florida from red tide areas

tingling, burning sensation and numbness of


lips, tongue, face, spreading elsewhere in the
dinoflagellate body; weakness, dizziness, joint aches,
(Gonyaulax catenella); hypersalivation, intense thirst, difficulty in
paralytic shellfish poison, saxitoxin
Pacific coast of North swallowing, muscular paralysis, and death;
America extremely toxic; usually involved with the
eating of shellfish that have been feeding on
toxic dinoflagellates
Representative animals poisonous when eaten

Mollusks—octopus, squid, shellfish, and others

California mussel
these mollusks become poisonous to eat
(Mytilus
because of feeding on toxic dinoflagellates;
californianus); Pacific paralytic shellfish poison, saxitoxin
symptoms same as for dinoflagellates
coast of North
(Gonyaulax species)
America

butter clam
(Saxidomus giganteus); same as California mussel
Alaska to California

nausea, vomiting, diarrhea, weakness, fatigue;


whelk dizziness, photophobia (intolerance to light),
(Neptunea species); tetramine impaired vision, and dryness of the mouth;
Europe, Pacific region poison is believed to be restricted to the
salivary glands of the whelk

diarrhea, weakness of the legs, fatigue; cold


turban shell (Turbo
poison believed to be related to water produces a painful stinging sensation,
argyrostoma); tropical
ciguatoxin itching; the illness closely resembles ciguatera
Pacific Ocean
fish poisoning

flushing of the face, itching, urticaria


(stinging sensation of skin), sensation of
Callista shellfish constriction of the chest, abdominal pain,
(Callista a histamine-like substance, choline nausea, respiratory distress, asthmatic attacks,
brevisiphonata); Japan paralysis, hypersalivation, numbness of the
tongue, throat; recovery usually within 10
days

Arthropods—joint-legged animals: crabs, spiders, and others

nausea, vomiting, diarrhea, muscular


shore crab (Demania weakness, respiratory distress, difficulty in
unknown
toxica); Philippines speaking, hypersalivation, muscular paralysis,
convulsions, death

crab (Zozymus similar to tetrodotoxin; toxicity of these tingling about the mouth, nausea, vomiting,
aeneus); Indo-Pacific crabs variable muscular paralysis, coma, convulsions, death

Asiatic horseshoe crab dizziness, headache, nausea, vomiting,


(Tachypleus abdominal pain, cardiac palpitation, numbness
unknown
tridentatus); Southeast of the lips, weakness, muscular paralysis,
Asia hypersalivation, loss of consciousness, death

Sharks, eels, and other fish

nausea, vomiting, diarrhea, abdominal pain,


Greenland shark unknown; flesh toxic; liver of tropical
tingling and burning sensation of the tongue,
(Somniosus sharks very toxic and may also cause
throat, and esophagus, muscular cramps,
microcephalus); Arctic death
respiratory distress, coma, death
Representative animals poisonous when eaten

symptoms may develop rapidly or slowly;


tingling about the lips, tongue, and throat,
followed by numbness, nausea, vomiting,
abdominal cramps, muscular weakness,
moray eel paralysis, convulsions, teeth feeling loose,
(Gymnothorax visual impairment, skin rash, hot objects
ciguatoxin*
javanicus); Indo- feeling cold and vice versa ("Dry Ice" or
Pacific** "electric shock" sensation); loss of muscular
coordination, coma, death in about 12 percent
of the cases; known as ciguatera fish
poisoning, this is one of the most common
forms of fish poisoning

red snapper (Lutjanus


same as moray eel
bohar); Indo-Pacific**

metallic taste, nausea, vomiting, abdominal


pain, vascular collapse, hypersalivation,
numbness, muscular paralysis, convulsions,
Chinese gizzard shad
coma, death; this form of poisoning develops
(Clupanodon thrissa); clupeotoxin, chemical nature unknown
rapidly and violently; mortality rate is about
Indo-Pacific
50 percent and death may come within a few
minutes; this form of fish poisoning is known
as clupeotoxism; no known antidote

castor-oil fish
produces a painless diarrhea; poisoning
(Ruvettus pretiosus);
oleic acid known as gempylotoxism; no treatment
tropical Atlantic,
needed
Indo-Pacific

saurine, a histamine-like substance;


scombroid fishes (mackerels, tunas,
the symptoms of acute scombroid poisoning
swordfishes, and allies) contain a
resemble those of severe allergy: sharp,
skipjack tuna chemical constituent in their flesh
peppery taste, headache, throbbing of the
(Euthynnus pelamis); called histidine; when histidine is acted
large blood vessels of the neck, nausea,
tropical seas upon, it forms a histamine-like
vomiting, massive red welts, and intense
bluefin tuna (Thunnus substance called saurine; this occurs
itching; recovery after 8–12 hours; this is
thynnus); subtropical when the fishes are permitted to stand
probably the most common and cosmopolitan
and temperate seas at room temperature for several hours;
form of fish poisoning; antihistamines are
scombroid fishes are more susceptible
used for treatment
to the development of saurine poison
than most other kinds of fishes

tingling of lips and tongue, loss of motor


coordination, floating sensation,
poison puffer
hypersalivation, numbness of the entire body,
(Arothron hispidus);
tetrodotoxin muscular paralysis, difficulty in swallowing,
tropical Pacific, Indian
weakness, nausea, vomiting, convulsions,
Ocean, Red Sea
about 60 percent fatality in humans; no known
antidote

Amphibians
Representative animals poisonous when eaten

California newt tarichatoxin; poison said to be identical


effects in humans are unknown; no known
(Taricha torosa); to tetrodotoxin; the eggs of this newt
antidote
California are extremely toxic

Reptiles

hawksbill turtle
(Eretmochelys nausea, vomiting, diarrhea; burning sensation
imbricata); tropical of lips, tongue, mouth; tightness of the chest,
chelonitoxin, chemistry unknown; the
seas difficulty in swallowing, hypersalivation, foul
flesh of some species of marine turtles
leatherback turtle breath, skin rash, sloughing of the skin,
is extremely poisonous
(Dermochelys enlargement of the liver, coma, death; fatality
coriacea); temperate rate is high; no known antidote
and tropical seas

Mammals

sei whale
intense headache, neck pain, photophobia,
(Balaenoptera
unknown; livers of many marine desquamation (peeling in scales) around the
borealis); North
mammals are toxic mouth and face, flushing of the face;
Pacific and North
antihistamines are used in treatment
Atlantic oceans

white whale
flesh is poisonous and has caused fatalities in
(Delphinapterus unknown
humans; no known antidote
leucas); Arctic seas

intense throbbing headaches, nausea,


polar bear (Thalarctos vitamin A and possibly other toxic vomiting, diarrhea, abdominal pain, dizziness,
maritimus); Arctic substances drowsiness, irritability, muscle cramps, visual
disturbances, collapse, coma, rarely death

References

1. CDC. Case definitions for public health surveillance. MMWR 1990;39(No. RR-13).
2. CDC. Case definitions for infectious conditions under public health surveillance. MMWR 1997;46(No. RR-10).
3. Knight B. Ricin---a potent homicidal poison. BMJ 1979;1:350--1.
4. Sidell FR. Riot control agents. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of chemical and
biological warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute, Walter Reed Army
Medical Center; 1997:307--24.
5. Nelson LS. Simple asphyxiants and pulmonary irritants. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS,
Nelson LS, eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1453--69.
6. Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J, eds. Respiratory toxicology. In: Ellenhorn's medical toxicology: diagnosis and
treatment of human poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996:1448--531.
7. Agency for Toxic Substances and Disease Registry. Toxicological profile for ammonia. Atlanta, GA: Agency for Toxic Substances
and Disease Registry, Division of Toxicology; 2002. Available at http://www.atsdr.cdc.gov/toxprofiles/tp126.html.
8. Ford M. Arsenic. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS, eds. Goldfrank's
toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1183--95.
9. Bolliger CT, van Zijl P, Louw JA. Multiple organ failure with the adult respiratory distress syndrome in homicidal arsenic poisoning.
Respiration 1992;59:57--61.
10. Civantos DP, Lopez RA, Aguado-Borruey JM, Narvaez JA. Fulminant malignant arrhythmia and multiorgan failure in acute arsenic
poisoning. Chest 1995;108:1774--5.
11. Heyman A, Pfeiffer JB Jr, Willett RW, Taylor HM. Peripheral neuropathy caused by arsenical intoxication. A study of 41 cases with
observations on the effects of BAL (2,3 dimercapto-propanol). N Engl J Med 1956;254:401--9.
12. Fowler BA, Weissberg JB. Arsine poisoning. N Engl J Med 1974;291:1171--4.
13. Hatlelid KM, Brailsford C, Carter DE. Reactions of arsine with hemoglobin. J Toxicol Environ Health 1996;47:145--57.
14. Pinto SS. Arsine poisoning: evaluation of the acute phase. J Occup Med 1976;18: 633--5.
15. Sigue G, Gamble L, Pelitere M, et al. From profound hypokalemia to life-threatening hyperkalemia: a case of barium sulfide
poisoning. Arch Intern Med 2000;160:548--51.
16. Shankle R, Keane JR. Acute paralysis from inhaled barium carbonate. Arch Neurol 1988;45:579--80.
17. Choudhury H, Cary R. Concise international chemical assessment document: barium and barium compounds. Geneva, Switzerland:
World Health Organization; 2001. Available at http://www.inchem.org/documents/cicads/cicads/cicad33.htm.
18. Johnson CH, VanTassell VJ. Acute barium poisoning with respiratory failure and rhabdomyolysis. Ann Emerg Med 1991;20:1138--
42.
19. CDC. Barium toxicity after exposure to contaminated contrast solution---Goias State, Brazil, 2003. MMWR 2003;52:1047--8.
20. US Department of Health and Human Services. Second national report on human exposure to environmental chemicals. Washington,
DC: US Department of Health and Human Services, CDC, National Center for Environmental Health; 2003. Available
at http://www.cdc.gov/exposurereport.
21. Morris PD, Campbell DS, Taylor TJ, Freeman JI. Clinical and epidemiological features of neurotoxic shellfish poisoning in North
Carolina. Am J Public Health 1991;81:471--4.
22. Trainer VL, Edwards RA, Szmant AM, Stuart AM, Mende TJ, Baden DG. Brevetoxins: unique activators of voltage-sensitive sodium
channels. In: Hall S, Strichartz G, eds. Marine toxins. Washington, DC: American Chemical Society; 1990:166--75.
23. Poli MA, Musser SM, Dickey RW, Eilers PP, Hall S. Neurotoxic shellfish poisoning and brevetoxin metabolites: a case study from
Florida. Toxicon 2000;38:981--93.
24. Tunik MG, Goldfrank LR. Food poisoning. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS,
eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1085--99.
25. Backer LC, Fleming LE, Rowan A, et al. Recreational exposure to aerosolized brevetoxins during Florida red tide events. Harmful
Algae 2003;2:19--28.
26. Shannon MW. Bromine and iodine compounds. In: Haddad LM, Shannon MW, Winchester JF, eds. Clinical management of
poisoning and drug overdose. 3rd ed. Philadelphia, PA: W.B. Saunders; 1998:803--12.
27. Morabia A, Selleger C, Landry JC, Conne P, Urban P, Fabre J. Accidental bromine exposure in an urban population: an acute
epidemiological assessment. Int J Epidemiol 1988;17:148--52.
28. Ketchum JS, Sidell FR. Incapacitating agents. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of
chemical and biologic warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute, Walter Reed
Army Medical Center; 1997:287--305.
29. Byrd GD, Paule RC, Sander LC, Sniegoski LT, White E 5th, Bausum HT. Determination of 3-quinuclidinyl benzilate (QNB) and its
major metabolites in urine by isotope dilution gas chromatography/mass spectrometry. J Anal Toxicol 1992;16:182--7.
30. Balzan MV, Agius G, Galea DA. Carbon monoxide poisoning: easy to treat but difficult to recognize. Postgrad Med J 1996;72:470--3.
31. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998;339:1603--8.
32. Tomaszewski C. Carbon monoxide. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS, eds.
Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1478--92.
33. Rao RB, Hoffman RS. Caustics and batteries. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson
LS, eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1323--45.
34. Alford BR, Harris HH. Chemical burns of the mouth, pharynx and esophagus. Ann Otol Rhinol Laryngol 1959;68:122--8.
35. Cello JP, Fogel RP, Boland CR. Liquid caustic ingestion: spectrum of injury. Arch Intern Med 1980;140:501--4.
36. Crain EF, Gershel JC, Mezey AP. Caustic ingestions: symptoms as predictors of esophageal injury. Am J Dis Child 1984;138:863--5.
37. Agency for Toxic Substances and Disease Registry. Medical Management Guidelines (MMGs) for Chlorine (Cl 2). Atlanta, GA:
Agency for Toxic Substances and Disease Registry, Division of Toxicology; 2004. Available
at http://www.atsdr.cdc.gov/MHMI/mmg172.html.
38. Urbanetti JS. Toxic inhalational injury. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of chemical
and biological warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute, Walter Reed Army
Medical Center; 1997:247--70.
39. Milne ST, Meek PD. Fatal colchicine overdose: report of a case and review of the literature. Am J Emerg Med 1998;16:603--8.
40. Tracqui A, Kintz P, Ludes B, Rouge C, Douibi H, Mangin P. High-performance liquid chromatography coupled to ion spray
spectrometry for the determination of colchicine at ppb levels in human biofluids. Chromatogr B: Biomed Sci Appl, 1996;675:235--
42.
41. Curry SC. Hydrogen cyanide and inorganic cyanide salts. In: Sullivan JB, Krieger GR, eds. Hazardous materials toxicology: clinical
principles of environmental health. Baltimore, MD: Williams & Wilkins; 1992:698--710.
42. Baskin SI, Brewer TG. Cyanide poisoning. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of
chemical and biological warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute, Walter
Reed Army Medical Center; 1997:271--86.
43. Kerns W II, Isom G, Kirk MA. Cyanide and hydrogen sulfide. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA,
Hoffman RS, Nelson LS, eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1498--514.
44. Smith TW, Antman EM, Friedman PL, Blatt CM, Marsh JD. Digitalis glycosides: mechanisms and manifestations of toxicity [Part I].
Prog Cardiovasc Dis 1984;26:413--58.
45. Rosen MR, Wit AL, Hoffman BF. Electrophysiology and pharmacology of cardiac arrhythmias. IV. Cardiac antiarrhythmic and toxic
effects of digitalis. Am Heart J 1975;89:391--9.
46. Hack JB, Lewin NA. Cardiac glycosides. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS,
eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:724--40.
47. Benowitz NL. Cardiac glycosides. In: Olsen KR, Anderson IB, Benowitz NL, et al., eds. Poisoning and drug overdose. 4th ed. New
York, NY: McGraw-Hill; 2004:155--7.
48. Agency for Toxic Substances and Disease Registry. Toxicological profile for white phosphorus. Atlanta, GA: Agency for Toxic
Substances and Disease Registry, Division of Toxicology; 2001. Available at http://www.atsdr.cdc.gov/toxprofiles/tp103.html.
49. Harbison RD. Phosphorus. In: Harbison RD, ed. Hamilton and Hardy's industrial toxicology. 5th ed. St Louis, MO: Mosby-Year
Book; 1998:194--7.
50. Simon FA, Pickering LK. Acute yellow phosphorus poisoning: smoking stool syndrome. JAMA 1976;235:1343--66.
51. Talley RC, Linhart JW, Trevino AJ, Moore L, Beller BM. Acute elemental phosphorus poisoning in man: cardiovascular toxicity. Am
Heart J 1972;84:139--40.
52. Seamens CM, Seger DL, Meredith T. Hydrofluoric acid. In: Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical toxicology.
Philadelphia, PA: W.B. Saunders; 2001:1019--26.
53. Lepke S, Passow H. Effects of fluoride on potassium and sodium permeability of the erythrocyte membrane. J Gen Physiol
1968;51(suppl):365S--72S.
54. McIvor ME, Cummings CE, Mower MM, et al. Sudden cardiac death from acute fluoride intoxication: the role of potassium. Ann
Emerg Med 1987;16:777--81.
55. Corke PJ. Superwarfarin (brodifacoum) poisoning. Anaesth Intensive Care 1997;25:707--9.
56. Kruse JA, Carlson RW. Fatal rodenticide poisoning with brodifacoum. Ann Emerg Med 1992;21:331--6.
57. Chua JD, Friedenberg WR. Superwarfarin poisoning. Arch Intern Med 1998;158:1929--32.
58. Sue Y-J Sue. Mercury. In: Goldfrank LR, Flomenbaum ME, Lewin NE, Howland MA, Hoffman RS, Nelson LS, eds. Goldfrank's
toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1239--
59. CDC. Current trends acute and chronic poisoning from residential exposures to elemental mercury---Michigan, 1989--1990. MMWR
1991;40:393--5.
60. CDC. Elemental mercury poisoning in a household---Ohio, 1989. MMWR 1990;39:424--5.
61. Agency for Toxic Substances and Disease Registry. Toxicologic profile for mercury. Atlanta, GA: Agency for Toxic Substances and
Disease Registry, Division of Toxicology; 1999. Available at http://www.atsdr.cdc.gov/toxprofiles/tp46.html.
62. Troen P, Kaufman SA, Katz KH. Mercuric bichloride poisoning. N Eng J Med 1951;244:459--63.
63. Hill WH. A report on two deaths from exposure to the fumes of a di-ethyl mercury. Can J Pub Health 1943;34:158--60.
64. Hook O, Lundgren KD, Swensson A. On alkyl mercury poisoning with ad description of two cases. Acta Med Scand 1954;150:131--7.
65. Nierenberg DW, Nordgren RE, Chang MB, et al. Delayed cerebellar disease and death after accidental exposure to dimethylmercury.
N Eng J Med 1998;338:1672--76.
66. Bakir F., Damluji SF, Amin-Zaki L. Methylmercury poisoning in Iraq. Science 1973;181: 230--41.
67. 67. Reigart JR, Roberts JR, eds. Fumigants. In: Recognition and management of pesticide poisonings. 5th ed. Washington, DC:
Environmental Protection Agency, Office of Pesticide Programs; 1999:156--68. Available
at http://www.epa.gov/pesticides/safety/healthcare.
68. Calvert GM, Mueller CA, Fajen JM, et al. Health effects associated with sulfuryl fluoride and methyl bromide exposure among
structural fumigation workers. Am J Public Health 1998;88:1774--80.
69. Deschamps FJ, Turpin JC. Methyl bromide intoxication during grain store fumigation. Occup Med 1996;46:89--90.
70. Marraccini JV, Thomas GE, Ongley JP, Pfaffenberger CD, Davis JH, Bednarczyk LR. Death and injury caused by methyl bromide---
an insecticide fumigant. J Forensic Sci 1983;28:601--7.
71. Harbison RD, SleemanR RZ. Methyl bromide. In: Harbison RD, ed. Hamilton and Hardy's industrial toxicology. 5th ed. St Louis,
MO: Mosby-Year Book; 1998:305--7.
72. Hathaway GJ, Proctor NH, Huges JP, eds. Methyl isocyanate. Proctor and Hughes' chemical hazards of the workplace. 4th ed. New
York, NY: John Wiley; 1996: 432.
73. Mehta PS, Mehta AS, Mehta SJ, Makhijani AB. Bhopal tragedy's health effects: a review of methyl isocyanate toxicity. JAMA
1990;264:2781--7.
74. Rye WA. Human responses to isocyanate exposure. J Occup Med 1973;15:306--7.
75. Misra NP, Pathak R, Gaur KJ, et al. Clinical profile of gas leak victims in acute phase after Bhopal episode. Indian J Med Res
1987;86(suppl):11--9.
76. Sidell FR. Soman and sarin: clinical manifestations and treatment of accidental poisoning by organophosphates. Clin Toxicol
1974;7:1--17.
77. Sidell FR. Nerve agents. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of chemical and biological
warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute, Walter Reed Army Medical Center;
1997:129--79.
78. Holstege CP, Kirk M, Sidell FR. Chemical warfare: nerve agent poisoning. Crit Care Clin 1997;13:923--42.
79. CDC. Green tobacco sickness in tobacco harvesters---Kentucky, 1992. MMWR 1993;42:237--40.
80. CDC. Nicotine poisoning after ingestion of contaminated ground beef---Michigan, 2003. MMWR 2003;52:413--16.
81. Nelson LS. Opioids. In: Goldfrank LR, Flomenbaum NE, Lewin N-A, Howland MA, Hoffman RS, Nelson LS, eds. Goldfrank's
toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:901--23.
82. Sporer KA. Acute heroin overdose. Ann Intern Med 1999;130:584--90.
83. Bismuth C, Garnier R, Baud FJ, Muszynski J, Keyes C. Paraquat poisoning: an overview of the current status. Drug Saf 1990;5:243--
51.
84. Bismuth C, Garnier R, Dally S, Fournier PE, Scherrmann JM. Prognosis and treatment of paraquat poisoning: a review of 28 cases. J
Toxicol Clin Toxicol 1982;19:461--74.
85. Vale JA, Meredith TJ, Buckley BM. Paraquat poisoning: clinical features and immediate general management. Hum Toxicol
1987;6:41--7.
86. Agency for Toxic Substances and Disease Registry. Medical management guidelines (MMGs) for phosgene (COCl 2). Atlanta, GA:
Agency for Toxic Substances and Disease Registry, Division of Toxicology; 2004. Available
at http://www.atsdr.cdc.gov/MHMI/mmg176.html.
87. US Army Medical Research Institute of Chemical Defense. Pulmonary agents. In: Medical management of chemical casualties
[Handbook]. 3rd ed. Aberdeen Proving Ground, MD: US Army Medical Research Institute of Chemical Defense, Chemical Casualty
Care Division; 2000:19--35.
88. Baselt RC, Cravey RH, eds. Phosphine. In: Disposition of toxic drugs and chemicals in man. 4th ed. Foster City, CA: Chemical
Toxicology Institute; 1995:628.
89. Harbison RD. Phosphorus. In: Harbison RD, ed. Hamilton and Hardy's industrial toxicology. 5th ed. St Louis, MO: Mosby-Year
Book; 1998:194--7.
90. Hathaway GJ, Proctor NH, Hughes JP, eds. Phosphine. In: Proctor and Hughes' chemical hazards of the workplace. 4th ed. New York,
NY: John Wiley; 1996:516--7.
91. Carter DE, Sullivan JB Jr. Intermetallic semiconductors: arsine, phosphine, and inorganic hydrides. In: Sullivan JB Jr, Krieger GR,
eds. Clinical environmental health and toxic exposures. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:958--63.
92. Ellenhorn MJ, Barceloux DG, eds. Ornamental beans. In: Medical toxicology: diagnosis and treatment of human poisonings. New
York, NY: Elsevier; 1997:1225--7.
93. Kortepeter MG, Parker GW. Potential biological weapons threats. Emerg Infect Dis 1999;5:523--7.
94. US Army Medical Research Institute of Infectious Diseases. Ricin. In: Eitzen E, Pavlin J, Cieslak T, Christopher G, Culpepper R, eds.
Medical management of biological casualties [Handbook]. 4th ed. Fort Detrick: MD: US Army Medical Research Institute of
Infectious Diseases, Operational Medical Division; 2001:101--6.
95. Franz DR, Jaax NK. Ricin toxin. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical aspects of chemical and
biological warfare. Washington, DC: US Department of the Army; 1997:631--42.
96. Danto BL. Medical problems and criteria regarding the use of tear gas by police. Am J Forensic Med Pathol 1987;8:317--22.
97. Fraunfelder FT. Is CS gas dangerous? Current evidence suggests not but unanswered questions remain. BMJ 2000;320:458--9.
98. Hill AR, Silverberg NB, Mayorga D, Baldwin HE. Medical hazards of the tear gas CS: case of persistent, multisystem,
hypersensitivity reaction and review of the literature. Medicine [Baltimore] 2000;79:234--40.
99. Hu H., Fine J, Epstein P, Kelsey K, Reynolds P, Walker B. Tear gas---harassing agent or toxic chemical weapon? JAMA
1989;262:660--3.
100. Thomas RJ, Smith PA, Rascona DA, Louthan JD, Gumpert B. Acute pulmonary effects from o-chlorobenzylidenemalonitrile "tear
gas": a unique exposure outcome unmasked by strenuous exercise after a military training event. Mil Med 2002;167:136--9.
101. Varma S, Holt PJ. Severe cutaneous reaction to CS gas. Clin Exp Dermatol 2001;26:248--50.
102. Gessner BD, Middaugh JP, Doucette GJ. Paralytic shellfish poisoning in Kodiak, Alaska. West J Med 1997:67:351--3.
103. Janiszewski L. The action of toxins on the voltage-gated sodium channel. Pol J Pharmacol Pharm 1990;42:581--8.
104. Rodrigue DC, Etzel RA, Hall S, et al. Lethal paralytic shellfish poisoning in Guatemala. Am J Trop Med Hyg 1990;42:267--71.
105. Shoff WH, Shepherd SM. Scombroid, ciguatera, and other seafood intoxications. In: Ford MD, Delaney KA, Ling LJ, Erickson T, eds.
Clinical toxicology. Philadelphia, PA: W.B. Saunders; 2001:959--69.
106. Tunik MG, Goldfrank LR. Food poisoning. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS,
eds. Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill; 2002:1085--99.
107. Hitt JM. Automobile airbag industry toxic exposures. In: Sullivan JB Jr, Krieger GR, eds. Hazardous materials toxicology: clinical
principles of environmental health. Baltimore, MD: Williams & Wilkins; 1992:533--6.
108. Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J, eds. Explosives. In: Ellenhorn's medical toxicology: diagnosis and treatment
of human poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins; 1997:1363--94.
109. Chi CH, Chen KW, Chan SH, Wu MH, Huang JJ. Clinical presentation and prognostic factors in sodium monofluoroacetate
intoxication. J Toxicol Clin Toxicol 1996;34:707--12.
110. Egekeze JO, Oehme FW. Sodium monofluoroacetate (SMFA, compound 1080): a literature review. Vet Hum Toxicol 1979;21:411--6.
111. Eason C. Sodium monofluroroacetate (1080) risk assessment and risk communication. Toxicology 2002:181--2, 523--30.
112. Flomenbaum NE. Rodenticides. In: Goldfrank LR, Flomenbaum ME, Lewin NE, Howland MA, Hoffman RS, Nelson LS, eds.
Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw Hill, 2002:1379--92.
113. Edmunds M, Sheehan TM, Van't Hoff W. Strychnine poisoning: clinical and toxicological observations of a non-fatal case. J Toxicol
Clin Toxicol 1986;24:245--55.
114. Smith BA. Strychnine poisoning [review]. J Emerg Med 1990;321--5.
115. Perper JA. Fatal strychnine poisoning---a case report and review of the literature. J Forensic Sci 1985;30:1248--55.
116. Calvert GM, Mueller CA, Fajen JM, et al. Health effects associated with sulfuryl fluoride and methyl bromide exposure among
structural fumigation workers. Am J Public Health 1998;88:1774--80.
117. CDC. Fatalities resulting from sulfuryl fluoride exposure after home fumigation---Virginia. MMWR 1987;36:602--4, 609--11.
118. Scheuerman EH. Suicide by exposure to sulfuryl fluoride. J Forensic Sci 1986;31:1154--8.
119. Sims JK, Ostman DC. Pufferfish poisoning: emergency diagnosis and management of mild human tetrodotoxication. Ann Emerg Med
1986;15:1094--8.
120. Torda TA, Sinclair E, Ulyatt DB. Puffer fish (tetrodotoxin) poisoning: clinical record and suggested management. Med J Aust
1973;1:599--602.
121. Ferguson TJ. Thallium. In: KR Olson, ed. Poisoning & drug overdose. 4th ed. New York, NY: McGraw-Hill; 2004:352--54.
122. Mulkey JP, Oehme FW. A review of thallium toxicity. Vet Hum Toxicol 1993;35:445--53.
123. Mercurio M, Hoffman R. Thallium. In: Goldfrank LR, Flomenbaum ME, Lewin NE, Howland MA, Hoffman RS, Nelson LS, eds.
Goldfrank's toxicologic emergencies. 7th ed. New York, NY: McGraw-Hill, 2002:1272--80.
124. Anderson IB. Ethylene glycol and other glycols. In: Olson KR, ed. Poisoning & drug overdose. 4th ed. New York, NY: McGraw-Hill;
2004:194--8.
125. Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology practice guidelines on the treatment of
ethylene glycol poisoning. J Toxicol Clin Toxicol 1999;37:537--60.
126. Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of ethylene glycol poisoning: methylpyrazole for toxic alcohols
study group. N Engl J Med 1999;30:832--8.
127. Hanif M, Mobarak MR, Ronan A, Ralman D, Donovan JJ Jr, Bennish ML. Fatal renal failure caused by diethylene glycol in
paracetamol elixir: the Bangladesh epidemic. BMJ 1995;311:88--91.
128. Wannemacher RW Jr, Wiener SL. Trichothecene mycotoxins. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine:
medical aspects of chemical and biologic warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden
Institute, Walter Reed Army Medical Center; 1997:655--77.
129. Croft WA, Jastromski BM, Croft AL, Peters HA. Clinical confirmation of trichothecene mycotoxicosis in patient urine. J Environ Biol
2002;23:301--20.
130. Vojdani A, Thrasher HD, Madison RA, Gray MR, Heuser G, Campbell AW. Antibodies to molds and satratoxin in individuals
exposed in water-damaged buildings. Arch Environ Health. 2003;58:421--32.
131. Tuomi T, Reijula K, Johnsson T, et al. Mycotoxins in crude building materials from water-damaged buildings. Appl Environ
Microbiol 2000;66:1899--904.
132. Stahl CJ, Green CC, Farnum JB. The incident at Tuol Chrey: pathologic and toxicologic examinations of a casualty after chemical
attack. J Forensic Sci 1985;30:317--37.
133. Borak J, Sidell FR. Agents of chemical warfare: sulfur mustard. Ann Emerg Med 1992;21:303--8.
134. Sidell FR, Urbanetti JS, Smith WJ, Hurst CG. Vesicants. In: Zajtchuk R, Bellamy RF, eds. Textbook of military medicine: medical
aspects of chemical and biologic warfare. Washington, DC: Office of the Surgeon General at TMM Publications, Borden Institute,
Walter Reed Army Medical Center; 1997:197--228.
135. Siegel D, Younggren BN, Ness B, Kvool V. Operation Castle Cascade: managing multiple casualties from a simulated chemical
weapons attack. Mil Med 2003;168:351--4.

You might also like