paraquat glyphosate and chlorpyrifos were recently banned in Thailand

1. Pesticide
1
Nut Sangjumrus, 3 rd year resident
Occupational medicine, KKU

2. 2

3. 3

4. 1.Paraquat
2.Glyphosate
3.Chlorpyrifos
4

5. 794.5M
http://www.doa.go.th/ard/wp-content/uploads/2020/01/HASTAT62_01รายงานสรุปการนำเข้าวัตถุอันตรายทางการเกษตร-ปี-พ.ศ.-๒๕๖๑-รายละเอียด-.pdf 5

6. http://www.doa.go.th/ard/wp-content/uploads/2020/02/HASTAT62_03.pdf 6

7. CONTENT
1. What is pesticide ?
2. Type of pesticide
• Paraquat
• Glyphosate
• Chlorpyrifos
3. Medical surveillance of OPCM
4. Related law
7

8. 1.WHATISPESTICIDE???
8

9. 1.WHATISPESTICIDE???
9

10. 1.WHATISPESTICIDE???
10

11. • insecticides,
• herbicides,
• rodenticides,
• fungicides.
2.TYPEOFPESTICIDE
WELL KNOWN PESTICIDE
• algicides
• fumigants
• ovicides
LESS KNOWN PESTICIDE
11

12. 2.TYPEOFPESTICIDE
http://envocc.ddc.moph.go.th/contents/view/106 12

13. 2.TYPEOFPESTICIDE
http://envocc.ddc.moph.go.th/contents/view/106 13

14. PARAQUAT
GLYPHOSATE
CHLORPYRIFOS
(INSECTICIDE)
(HERBICIDE)
(HERBICIDE)
14

15. PARAQUAT
15

16. HEALTH EFFECT
PARAQUAT
MILD TOXICITY MODERATE TOXICITY SEVERE TOXICITY
https://webwiser.nlm.nih.gov/substance?substanceId=528&identifier=Paraquat&identifierType=name&menuItemId=62&catId=83 16

17. HEALTH EFFECT
PARAQUAT
MILD TOXICITY
https://webwiser.nlm.nih.gov/substance?substanceId=528&identifier=Paraquat&identifierType=name&menuItemId=62&catId=83 17
CAUSTIC INJURY TO THE ORAL
MUCOSA AND ESOPHAGUS.
NAUSEA AND VOMITING
ARE COMMON.
SYMPTOMS USUALLY
RESOLVE IN PATIENTS
WITH A MILD EXPOSURE.
MILD TOXICITY: Ingestion of less than 20 mg paraquat ion
per kg body weight (less than 7.5 mL of 20% [w/v]
paraquat concentrate): No symptoms or mild GI effects

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:

20. Chronic effect
• increased risk of parkinson disease ?
• cellulitis ,NF ?
PARAQUAT
HEALTH EFFECT
20

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

23. GLYPHOSATE
23

24. https://www.eenews.net/stories/1060332679
https://www.bbc.com/news/world-us-canada-45152546?SThisFB&fbclid=IwAR1x1voFFx9mFFyGCeNYATqP69Novl7NFTWBWjFRUVLcLlmmx0-VVGX7E_0#
24

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

27. CHLORPYRIFOS
27

28. • Nicotinic symptom
• Muscarinic symptom
• Intermediate syndrome
• OPDIP (OP-induced delayed
polyneuropathy)
ORGANOPHOSPHATE
Health effects
https://creativemeddoses.com/topics-list/organophosphate-poisoning/
28

29. Mechanism
https://creativemeddoses.com/topics-list/organophosphate-poisoning/
ORGANOPHOSPHATE
https://creativemeddoses.com/topics-list/organophosphate-poisoning/
29

30. • Urine alkyl phosphate metabolite test
• Plasma cholinesterase level
• RBC cholinesterase level
LABORATORYTESTING
FOR ORGANOPHOSPHATE
https://med.mahidol.ac.th/poisoncenter/sites/default/files/public/pdf/books/Pesticide_book-06_Glyphosate.pdf
30

31. 31

32. ACGIH 2020 32
True baseline is recommended !!!

33. Medical surveillance
ORGANOPHOSPHATE
33
• History
• Physical examination
• Investigation
http://envocc.ddc.moph.go.th/uploads/31858/1-56.pdf
นบก 1-56 ของ กองโรคจากการประกอบอาชีพ
Nicotinic, Muscarinic overstimulation
Cholinesterase level (RBC, plasma)
Urine alkyl phosphate metabolite test

34. Medical surveillance
ORGANOPHOSPHATE
• working baseline
• true baseline
• medical removal protection
• return to work level
34

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

38. RELATEDLAW
38

39. 39

40. 40

41. 41

42. 42

43. 43

44. 44

45. 45

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

47. -PARACELSUS
47
“ALLTHINGSAREPOISONS,FORTHEREISNOTHINGWITHOUT
POISONOUSQUALITIES.
ITISONLYTHEDOSEWHICHMAKESATHINGPOISON.”
THANKSFORATTENTION