What is the treatment for pesticide exposure?

From the Guidelines

Treatment for pesticide exposure involves immediate removal from the source and decontamination, with the goal of reducing morbidity, mortality, and improving quality of life. For skin exposure, remove contaminated clothing and wash the affected area with soap and water, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. According to the guidelines, immediate skin decontamination is recommended after a chemical exposure, and skin exposed to caustic chemicals should be irrigated with running water for at least 15 minutes 1.

Key Considerations

• Remove contaminated clothing, jewelry, and other surrounding material from the area of chemical exposure, as this can help prevent further absorption and contamination of caregivers and the care environment 1.
• Call poison control or seek emergency medical attention immediately, as early and effective treatment may prevent deterioration to respiratory and cardiac arrest 1.
• Medical treatment depends on the specific pesticide and may include activated charcoal to prevent absorption, atropine for organophosphate poisoning, pralidoxime (2-PAM) for severe organophosphate poisoning, or benzodiazepines for seizures 1.
• Supportive care, including oxygen, IV fluids, and respiratory support, may be necessary, and symptoms can vary by pesticide type, including nausea, vomiting, headache, dizziness, muscle twitching, respiratory difficulties, and altered mental status 1.

Decontamination Procedures

• For eye exposure, flush with clean water for 15-20 minutes, and for skin exposure, wash the affected area with soap and water 1.
• For dry chemicals, brushing off as much chemical powder as possible while avoiding spreading the contaminant to other areas may reduce the risk of caustic or thermal injury before irrigation with water 1.
• It is essential to follow local guidelines, chemical-specific procedures, or consult a regional poison center when assisting a person with chemical exposures, as some chemicals may require special decontamination procedures 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Organophosphate Poisoning Treatment should include general supportive care, atropinization, and decontamination, in addition to the use of PROTOPAM Chloride.

INDICATIONS AND USAGE PROTOPAM Chloride is indicated as an antidote: 1. In the treatment of poisoning due to those pesticides and chemicals (e.g., nerve agents) of the organophosphate class which have anticholinesterase activity

The treatment for pesticide exposure includes:

• General supportive care
• Atropinization: atropine should be given as soon as possible after hypoxemia is improved
• Decontamination: clothing should be removed and the hair and skin washed thoroughly with sodium bicarbonate or alcohol as soon as possible
• Administration of PROTOPAM Chloride: the dosage and administration of PROTOPAM Chloride vary depending on the severity of symptoms and the route of administration 2
• Supportive care: including airway management, respiratory and cardiovascular support, correction of metabolic abnormalities, and seizure control, may be necessary in cases of severe organophosphate poisoning 2

From the Research

Treatment for Pesticide Exposure

• The current standard of care (SOC) for pesticide exposure alleviates acute neurologic-, cardiovascular- and respiratory symptoms and reduces short-term mortality 3.
• Atropine and pralidoxime are commonly used in the treatment of organophosphate poisoning, with atropine having beneficial effects on the heart rate and prolonging the time before the heart rate declines 4.
• In cases of acute respiratory distress syndrome (ARDS) resulting from pesticide exposure, treatment is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury 5, 6, 7.
• Lung-protective ventilation, including low tidal volume and high positive end-expiratory pressure, can improve outcomes in patients with ARDS 5, 6.
• Prone positioning is recommended for some moderate and all severe cases of ARDS 5, 6.

Adjunctive Therapies

• Succinate prodrugs, such as NV354, have been shown to support mitochondrial function and reduce brain injury in a rodent model of acute organophosphate poisoning when used in combination with atropine and pralidoxime 3.
• Further research is needed to develop adjunctive therapies with novel targets to improve outcomes in patients with pesticide exposure 3.