Case history
Case history
A 50-year-old farmer with a history of alcohol abuse and depression is brought to the emergency department having deliberately ingested approximately 200 mL of a pesticide 4 hours previously. He is semi-conscious, has pinpoint pupils, and has large amounts of secretions pouring from his mouth. His heart rate is 120 bpm, blood pressure 90/60 mmHg, and oxygen saturation 65%. His chest has widespread crackles and rhonchi. Fine fasciculations are apparent in his peri-orbital, chest, and leg muscles. He has been incontinent of urine and faeces.
Other presentations
Presentation is highly variable due to differences in dose, agent toxicity, and type of exposure. Presentations after minor exposures (e.g., dermal) are common, but serious toxicity in this setting is very rare, with usual symptoms often being indistinguishable from influenza (e.g., fatigue, runny nose, headache, dizziness, anorexia, sweating, diarrhoea, and muscle weakness). Nausea, vomiting, and visual disturbances may also be seen. A distinctive odour from the solvent may be present. Severe poisoning (usually due to deliberate ingestion or chemical warfare) may present with seizures or respiratory failure. Delayed-onset central nervous system and peripheral (predominantly motor) neuropathy are uncommon, but may be severe and can lead to permanent disability.
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