18. HEALTH EFFECT
PARAQUAT
MODERATE
TOXICITY
THE PATIENT MAY DEVELOP
TRANSIENT RENAL, HEPATIC
AND RESPIRATORY
IMPAIRMENT.
https://webwiser.nlm.nih.gov/substance?substanceId=528&identifier=Paraquat&identifierType=name&menuItemId=62&catId=83 18
PATIENTS WITH MODERATE
TOXICITY CAN DEVELOP
PERMANENT PULMONARY
INJURY.
MODERATE to SEVERE TOXICITY: 20 to 40 mg paraquat ion per kg body weight
(7.5 to 15 mL of 20% [w/v] paraquat concentrate): Pulmonary fibroplasia develops.
Death occurs in most cases, but may be delayed 2 to 3 weeks.
19. HEALTH EFFECT
PARAQUAT
https://webwiser.nlm.nih.gov/substance?substanceId=528&identifier=Paraquat&identifierType=name&menuItemId=62&catId=83 19
SEVERE TOXICITY
FATAL: Greater than 40 mg paraquat ion per kg body weight (more than 15 mL of
20% [w/v] paraquat concentrate): Multiple organ failure occurs; toxicity progresses
rapidly. Mortality is essentially 100% in 1 to 7 days.
SEVERE PARAQUAT TOXICITY HAVE INGESTED
CONCENTRATED FORMS OF THE HERBICIDE.
PATIENTS MAY DIE IN THE FIRST SEVERAL DAYS DUE
TO GASTROINTESTINAL PERFORATIONS OR
MULTIORGAN FAILURE.
PATIENTS THAT SURVIVE THE EARLY PHASE OF
TOXICITY INVOLVING CARDIOVASCULAR, HEPATIC,
AND RENAL SYSTEMS DEVELOP PULMONARY
FIBROSIS AND SUBSEQUENT DEATH OVER THE
FOLLOWING 2 TO 4 WEEKS POSTINGESTION.• 3) EARLY FINDINGS may include:
21. • Pre-employment and annual medical examinations should be made available to all
persons who are regularly exposed to paraquat at potentially hazardous levels.
• Attention should be given to all normal parameters of overall health status, with
particular attention to the state of the skin and of pulmonary function. [1]
• There is no direct evidence that paraquat is a human carcinogen.[2]
PARAQUAT
[1] http://www.inchem.org/documents/hsg/hsg/hsg051.htm#PartNumber:4
[2] https://webwiser.nlm.nih.gov/substance?substanceId=528&identifier=Paraquat&identifierType=name&menuItemId=62&catId=83
21
22. • Plasma paraquat level
• Urine alkaline dithionite test
LABORATORYTESTING
FOR PARAQUAT
https://med.mahidol.ac.th/poisoncenter/sites/default/files/public/pdf/books/Pesticide_book-05_Paraquat.pdf
22
25. Health effects
GLYPHOSATE
increased risk of
autism?
skin and
gastrointestinal
irritation
https://med.mahidol.ac.th/poisoncenter/sites/default/files/public/pdf/books/Pesticide_book-06_Glyphosate.pdf
Carcinogenicity :
IARC 2A
In March 2015, (IARC) announced that
glyphosate probably caused a type of cancer
called non-Hodgkin’s lymphoma.
https://gmb.org.uk/sites/default/files/HS_Glyphosate.pdf
https://www.iarc.fr/wp-content/uploads/2018/11/QA_Glyphosate.pdf
25
26. • Blood glyphosate
LABORATORYTESTING
FOR GLYPHOSATE
https://med.mahidol.ac.th/poisoncenter/sites/default/files/public/pdf/books/Pesticide_book-06_Glyphosate.pdf
26
35. Medical surveillance
ORGANOPHOSPHATE
OSHA DOSH
Who to monitor?
• Individuals who apply Class I or II OP*
• Working 30 or more hours within any
30-day period
Any occupational exposure to OP.
What to measure?
both acetylcholinesterase and butyryl
cholinesterase
Plasma cholinesterase estimation is good
enough for medical surveillance.
However for treatment purposes, Red blood
cell cholinesterase estimation
* https://www.who.int/ipcs/publications/pesticides_hazard_rev_3.pdf 35
36. Medical surveillance
ORGANOPHOSPHATE
OSHA DOSH
action level
medical removal
protection
Medical Removal
>30% decrease in AchE
or
>40% decrease in PChE
1.plasma ACHE or rbc ACHE of less
than 50% of the pre-employment or
laboratory's normal level.
2.rbc ACHE of between 50 and 70%
of the pre-employment level showing
a fall of more than 10% in their repeat
test results.
evaluation workplace
>20% decrease from baseline in
AChE or PChE
-
36
37. Medical surveillance
ORGANOPHOSPHATE
OSHA DOSH
return to work
***Retest for Return to Work
• Days to repeat test is determined by degree
of ChE activity reduction.
• RBC: (% depression - 20) /0.83 = # of days
to repeat test
• plasma: (% depression - 20) / 1.2 = # of
days to repeat test
Return to work when test result is greater
than or equal to 80% of baseline.
All suspended cases should have
repeat plasma ACHE estimations at
monthly intervals.
The worker may return to work with OP
and/or CM when the plasma ACHE has
returned to more than 70% of the pre-
employment level.
37
46. • สารที่ขึ้นเป็นวัตถุอันตราย วอ.4 ได้แก่ paraquat and chlorpyrifos
• plasma-ChE มีความจำเพาะน้อยกว่า RBC-ChE
TAKEHOMEMESSAGE
OSHA DOSH
action level
medical removal
protection
Medical Removal
>30% decrease in AchE
or
>40% decrease in PChE
1.plasma ACHE or rbc ACHE of less than 50%
of the pre-employment or laboratory's
normal level.
2.rbc ACHE of between 50 and 70% of the
pre-employment level showing a fall of more
than 10% in their repeat test results.
evaluation workplace >20% decrease from baseline in AChE or PChE -
RTW
Return to work when test result is greater than or equal
to 80% of baseline.
The worker may return to work with OP and/or
CM when the plasma ACHE has returned to
more than 70% of the pre-employment level.
46
