Insecticide poisoning

Most household bug sprays contain plant-derived chemicals called pyrethrins. These chemicals were originally isolated from chrysanthemum flowers and are generally not harmful. However, they can cause life-threatening breathing problems if they are breathed in.

Stronger insecticides, which a farm or commercial greenhouse might use or someone might store in their garage, contain many dangerous substances. These include:

• Carbamates
• Organophosphates
• Paradichlorobenzenes (mothballs)

Various insecticides contain these chemicals.

Below are symptoms of insecticide poisoning in different parts of the body.

Symptoms of pyrethrin poisoning:

LUNGS AND AIRWAYS

• Breathing difficulty

NERVOUS SYSTEM

• Coma (decreased level of consciousness and lack of responsiveness)
• Seizures

SKIN

• Irritation
• Redness or swelling

Symptoms of organophosphate or carbamate poisoning:

HEART AND BLOOD

• Slow heart rate

LUNGS AND AIRWAYS

• Breathing difficulty
• Wheezing

NERVOUS SYSTEM

• Anxiety
• Coma (decreased level of consciousness and lack of responsiveness)
• Seizures
• Dizziness
• Headache
• Weakness

BLADDER AND KIDNEYS

• Increased urination

EYES, EARS, NOSE, AND THROAT

• Drooling from increased saliva
• Increased tears in the eyes
• Small pupils

STOMACH AND INTESTINES

• Abdominal cramps
• Diarrhea
• Loss of appetite
• Nausea and vomiting

SKIN

• Blue-colored lips and fingernails

Note: Serious poisoning can occur if an organophosphate gets on your bare skin or if you don't wash your skin soon after it gets on you. Large amounts of the chemical soak through the skin unless you are protected. Life-threatening paralysis and death can occur very quickly.

Symptoms of paradichlorobenzene poisoning:

EYES, EARS, THROAT, AND MOUTH

• Burning in mouth

LUNGS AND AIRWAYS

• Breathing problems (rapid, slow, or painful)
• Cough
• Shallow breathing

MUSCLES

• Muscle spasms

NERVOUS SYSTEM

• Changes in alertness
• Headache
• Slurred speech
• Weakness

SKIN

• Yellow skin (jaundice)

STOMACH AND INTESTINES

• Diarrhea
• Abdominal pain
• Nausea and vomiting

Note: Paradichlorobenzene mothballs are not very toxic. They have replaced the more toxic camphor and naphthalene types.

Get medical help right away. Do not make the person throw up unless poison control or a health care provider tells you to.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the person breathed in the poison, move them to fresh air right away.

Have this information ready:

• Person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may be done include:

• Blood and urine tests
• Bronchoscopy -- camera down the throat to look for burns in the airways and lungs
• Chest x-ray
• Electrocardiogram (ECG)
• Endoscopy -- camera down the throat to look for burns in the esophagus and the stomach

Treatment may include:

• Fluids by IV (through a vein)
• Medicines to counteract the poisonous effects, such as atropine
• Medicines to support the blood pressure or heart rate
• Medicine to treat symptoms
• Tube through the mouth into the stomach to empty the stomach (gastric lavage)
• Washing of the skin (irrigation), perhaps every few hours for several days
• Surgery to remove burned skin
• Breathing support, including tube through the mouth into the lungs and connected to a breathing machine (ventilator)

How well someone does depends on how severe the poisoning is and how quickly treatment is received. The faster medical help is given, the better the chance for recovery. Swallowing these poisons can have severe effects on many parts of the body.

It is a good sign that recovery will occur if the person continues to improve in the first 4 to 6 hours after they receive treatment.

Although the symptoms are the same for carbamate and organophosphate poisoning, it is harder to recover after organophosphate poisoning.

Organophosphate poisoning; Carbamate poisoning

Roberts DM, Bode M. Pesticides. In: Cameron P, Little M, Mitra B, Deasy C, eds. Textbook of Adult Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 25.15.

Welker KL, Thompson TM. Pesticides. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 152.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.