ABSTRACT
DDT: DDT and its analog, methoxychlor; low to moderate toxicity; not biodegradable and bioaccumulating in the environment. Lindane (for head lice): Moderate toxicity and in frequent use; consider OC poisoning from excessive lindane absorption in the differential diagnosis of pediatric seizure disorders. Cyclodienes: Aldrin, dieldrin, endrin, chlordane, chlordecone (Kepone®), and heptachlor (Mirex®); all highly toxic, some carcinogenic, and still in use illicitly in the United States and licitly in the developing world. Toxaphene: Moderate toxicity; infrequent use.
Representatives: DDT, lindane, cyclodienes. Mechanism: Prolonged opening of Na channels. Metabolism: Very lipid soluble; preferred absorption pathways include ingestion (gastrointestinal > inhalation (pulmonary) > dermal absorption; all OCs cytochrome P-450 inducers. Diagnosis: History, radiopacities on at and erect abdominal x-rays. Antidote: Dextrose and thiamine for seizures. Acute: Initially nausea and vomiting; then weakness, paresthesias, tremor, clonus, seizures, fever; seizure activity, respiratory paralysis, respiratory arrest. Chronic: Chlordane causes leukemia and thrombotic thrombocytopenic purpura (TTP); chlordecone causes pseudotumor cerebri and male infertility. Treatment: Skin decontamination; careful gastric lavage, then AC; seizure control with dextrose, thiamine, benzodiazepines, phenobarbital; cholestyramine to reduce chlordecone enterohepatic circulation. No oil cathartics
