Toxicants in Play

Contacto, Dela Cruz, Dumduma, Gabo, Gonzaga, Ignacio, Rivera,



Sabili, Yang
Background of the Study
 In 2004, the top five causes of death in low-
income countries were pneumonia, followed by
heart disease, diarrhea, HIV/AIDS and stroke
 Due to the expected economic growth in low and
middle-income countries, globally by 2030, the
four leading causes of death are predicted to be
ischemic heart disease, cerebrovascular
diseases, COPD, and lower respiratory
infections.
 Environmental exposures contribute significantly
to these diseases
 Identifying the various toxicants in the
environment is the first step in addressing the
expected prevalence of diseases in the years to
Statement of the Problem
 This study attempts to investigate the
possible toxicities arising from the
exposure to the playground toxicants. In
doing so, the researchers will be able to
validate the presence of the
hypothesized toxicant in the area.


Specifically, it aims to answer the



following:
 Are the pre-identified toxicants present in
the playground?
 Do the visitors and employees of the
playground show signs of toxicity from
Hypotheses
 Ha: The visitors and employees of the
Children’s Playground show signs of
toxicities from the playground toxicants.


 Ho: The visitors and employees of the

Children’s Playground do not show signs
of toxicities from the playground
toxicants.

Significance of the Study
ü The results of this study will be of great
importance to the creation of preventive
measures to protect the public from the
harmful effects of toxicants found in the
area.
ü Not only will the information generated from
this study be important in the treatment of
the presently prevailing diseases but also
in the early diagnosis of the patients who
had been exposed to the toxicants in the
area.
ü Furthermore, this study may also arouse the
concern of the government to look more
closely into the kind of environment that
Scope and Delimitations
ü The results of this study will only be
applicable to the area where we
conducted our research, the National
Park Development Committee:
Children’s Playground in T.M. Kalaw St.,
Ermita, Manila.
ü The questions that were asked in the
survey/ interview were based from the
signs and symptoms of the toxicants
pre-identified by the toxicology
students.
ü This study will not deal will the
Theoretical Background
Of the Toxicants

Organophosphates- the pesticide/
nerve gas
 Mechanism of Toxicity
 Organophosphate derivatives act by
combining with and inactivating the
enzyme acetylcholinesterase (AChE).
This inactivation is irreversible resulting
to accumulation of large amounts of
acetylcholine that will result to a
cholinergic crisis. It is to note that
organophosphate combination with the
enzyme will undergo aging within a few
minutes to some hours. This aging stage
removes one Phosphorus-oxygen bond
that makes the enzyme-OP bond
Organophosphates
 Cardinal Signs and Symptoms
 Visualdisturbances
 Respiratory difficulty
 Urinary incontinence


 Antidotes
 Atropine
 Pralidoxime

Carbamates- the carbamate
insecticide
 Mechanism of Toxicity
 Carbamate poisoning will result to a
similar mechanism with that of
organophosphates. They combine and
inactivate the acetylcholinesterase
enzyme which will lead to accumulation
of acetylcholine leading to cholinergic
crisis. However this is reversible since
the strength of the enzyme – OC bond is
weaker than the enzyme-OP bond and
aging does not occur.

Carbamates
 Cardinal Signs and Symptoms
 Same symptoms as ORGANOPHOSPHATES
 Extensive tearing
 Excessive weakness
 Dizziness


 Antidotes
 Atropine
Pyrethrum- the “Chrysanthemum”
organic insecticide

 Mechanism of Toxicity
 Binds to sodium channels, which cause
the delay in sodium channel closing, i.e.,
prolonged sodium inactivation. These
substances exhibit a negative after
potential, indicating that the axon does
not readily recover to its resting stage.
These substances also cause repetitive
discharges of axonal action potentials in
response to a single stimulus. Therefore,
it can be readily excited again. The
excessive neuroexcitation caused by
these substances results in
hyperactivity, tremors, and rigid
Pyrethrum
 Cardinal Signs and Symptoms
 Hypersensitivity reactions may occur. In the
skin, the usual lesion is a mild erythematous
dermatitis with vesicles, intense puritis and
a bullous dermatitis.


 Antidotes
Hypersensitivity reactions should be treated
with antihistamines, corticosteriods, and
bronchodilators
Anaphylaxis may require adrenaline
Contact dermatitis can be treated using
local corticosteroids.
Sodium Monofluoroacetate- pesticide, “the
coyote killer”

 Mechanism of Toxicity
 Fluoroacetate disrupts the citric acid cycle
(also known as the Krebs cycle) by
combining with coenzyme A to form
fluoroacetyl CoA, which reacts with
citrate synthase to produce fluorocitrate.
A metabolite of fluorocitrate binds very
tightly to aconitase, thereby halting the
citric acid cycle. This inhibition results in
an accumulation of citrate in the blood
which deprives cells of energy.
Sodium Monofluoroacetate
 Cardinal Signs and Symptoms
 Excitability
 Hyperactivity
 Convulsions


 Antidotes
 Monoacetin


Hypochlorite- the swimming pool
disinfectant
 Mechanism of Toxicity
 Intoxications with chlorate salts are
characterized by methemoglobin
formation, hemolysis and renal
insufficiency. It causes a biosynthetic
alteration in cellular metabolism and a
phospholipid destruction, a formation of
chloramines which interferes in cellular
metabolism, an oxidative action with
irreversible enzymatic inactivation in
bacteria, and a lipid and fatty acid
degradation
Hypochlorite
 Cardinal Signs and Symptoms
 Eye and throat irritation


 Antidotes
 Sodium thiosulfate

Camphor- rust protectant, “the moth
repellant”
 Mechanism of Toxicity
 Camphor specifically inhibits
catecholamine secretion by blocking ACh
without affecting agonist binding
 Camphor causes convulsions by stimulating
the cells of the cerebral cortex.

Camphor
 Cardinal Signs and Symptoms
 Vertigo
 Hallucinations
 Convulsions


 Antidotes
 Control convulsions with diazepam
Fluorides- insecticide “the ant
killer”
 Mechanism of Toxicity
 Fluoride binds to calcium and magnesium,
causing hypocalcemia and
hypomagnesemia.
 Fluoride disrupts many intracellular
mechanisms, including glycolysis, G-
protein mediated signalling, oxidative
phosphorylation, adenosine triphosphate
(ATP) production, function of NA/K-
ATPase, & potassium channels.

Fluorides
 Cardinal Signs and Symptoms
 Minor overexposure in children under age
10 can cause tooth mottling
 High chronic overexposure can cause
fluorosis
 white specks or black/ brown stains on teeth


 Antidotes
 Hypercalcemia-
IV Calcium Gluconate
 Hypomagnesemia- IV Magnesium sulfate


Sulfites- toxicant in bottled water
 Mechanism of Toxicity
 Ingestion of food containing sulfating
agents can result in Type 1 immediate
hypersensitivity reactions in normal,
non- asthmatic individuals
 Reactions have occurred without evidence
for IgE- mediated mechanisms in
asthmatics
Sulfites
 Cardinal Signs and Symptoms
 Beefy red skin rash, most often affecting
palms, soles, buttocks, and scrotum
 characteristic smell of rotten eggs in the
mouth


 Treatment
 If renal failure occurs, hemodialysis may
be necessary to sustain fluid balance
and normal extracellular fluid
composition
Diquat- the aquatic herbicide
 Mechanism of toxicity
 The mechanism of poisoning has not been
fully elucidated, but it is believed to
involve inhibition of superoxide
dismutase in the lungs, making the lungs
particularly susceptible to oxygen
toxicity.

Diquat
 Cardinal Signs and Symptoms
 Respiratory irritation
 Lung injury


 Antidotes
 Gastrointestinaldecontamination using
bentonite (7.5% suspension), Fuller’s
Earth (15% suspension), and activated
charcoal
Strychnine- pesticide “the
bitter killer”
 Mechanism of Toxicity
 Strychnine is a competitive antagonist of
the inhibitory neurotransmitter glycine at
receptors in the spinal cord, brain stem
and higher centers. It results in
increased neuronal activity and
excitability, leading to increased
muscular activity.

Strychnine
 Cardinal Signs and Symptoms
 Convulsions
 Uncontrollable arching of neck and back
 jaw tightness


 Treatment
 Treatment consists of removing the drug from
the body (decontamination) and getting
supportive medical care in a hospital setting
 Supportive care includes intravenous fluids
(fluids injected directly into a vein),
medications for convulsions and spasms,
and cooling measures for high temperature

Organochlorines- the insecticide
“DDT”
 Mechanism of Toxicity
 Toxicityin humans is largely due to
stimulation of the central nervous
system. The organochlorines disturb the
neuronal membrane causing
hyperexcitability of the nervous system.
Specifically, cyclodienes,
hexachlorocyclohexanes, and toxaphene
organochlorines inhibit GABA-mediated
chloride influx in the CNS, while DDT
affects potassium and voltage-
dependent sodium channels. These
changes can result in agitation,
confusion, and seizures. Cardiac effects
Organochlorines
 Cardinal Signs and Symptoms
 Headache, dizziness, nausea and vomiting
 Kidney and Liver failure

 Treatment
 Dermal decontamination
 GI decontamination- Cholestyramine may
be used alternatively to bind these
highly lipophilic agents. It reduces
reabsorption and retains bound agent in
the GI tract for fecal elimination.

Oxalic Acid- “the pulpwood
bleach”
 Mechanism of Toxicity
 Oxalates combines with serum calcium to
form an insoluble calcium oxalate. This
will lead to a decrease in the blood
calcium (Ca+2 ) level leading to violent
muscular stimulation with convulsions
and collapse.

Oxalic Acid
 Cardinal Signs and symptoms
 Anuria
 Cyanosis
 Slow healing ulcers


 Antidotes
 precipitate oxalate by giving calcium orally
Potassium Bromate- “the
dye”
 Mechanism of Toxicity
 On contact with acids, such as gastric
hydrochloric acid, potassium bromate
releases hydrogen bromate, which is
an irritating acid.

Potassium Bromate
 Cardinal Signs and symptoms
 Cyanosis
 Vomiting and collapse


 Antidotes
 Sodium thiosulfate
Sodium Perborate- “in cleaning
products & bleaches”
 Mechanism of toxicity
 It appears that boron has a special affinity
for the central nervous system, liver and
body fat
Sodium Perborate
 Cardinal signs and symptoms
 Boiledlobster appearance, erythematous
and exfoliative rash
 Anemia


 Antidotes
 SkinDecontamination- wash skin with
soap and water
 GI Decontamination- Remove poison by
ipecac emesis followed by activated
charcoal

Methodology
The Research Area

National


Park
Developme
nt
Committee
: Children’s
Playground
at T.M.
Kalaw St.,
Ermita,
Manila.

Interview Questionnaire
 The questions that were asked were based
on the signs and symptoms of the
toxicants pre-identified by the researchers.
 The questions were designed in such a way
that will validate the exposure to the
possible toxicants.
 Based on the number of positive responses
to each question, the researchers will be
able to identify if the respondents were
indeed suffering from intoxication due to
exposure to the toxicants.
 Twenty nine respondents were interviewed,
Interpretation and Analysis of
Results
Pre- identified Toxicants
Question No. Type of Toxicant Signs and Symptoms

1 Organophosphates Urinary incontinence, confusion, anxiety

2 Carbamates Extensive tearing, excessive weakness, dizziness

3 Pyrethrum Severe dermatitis

4 Na monofluoroacetate Hyperactivity, convulsions

5 Hypochlorite Eye and throat irritation

6 Camphor Vertigo, hallucinations

7 Fluorides Fluorosis, white specks or black/ brown specks on teeth

8 Sulfites Beefy red skin rash, most often affecting palms, soles, buttocks, and scrotum;
characteristic smell of rotten eggs in the mouth

9 Diquat Lung damage

10 Strychnine Uncontrollable arching of neck and back, jaw tightness

11 Organochlorines Liver and kidney failure

12 Oxalic Acid Slow healing ulcers

13 Potassium Bromate Cyanosis

14 Sodium Perborate Peeling of the skin particularly in the palm, soles or buttocks

15 Sodium Perborate Anemia

Survey Results
 Interpretation
 The data gathered from the survey show that majority of
the respondents do not exhibit any signs or symptoms of
toxicity from the pre-identified toxicants. On the other
hand, a significant number of respondents responded
positive to the survey questions


ü 59% of the respondents said that they experience

eye and throat irritation, a sign of hypochlorite
poisoning
ü

ü Poisoning with strychnine was also prevalent, signs

of which were uncontrollable arching of neck and
back accompanied by tightness of the jaw, which
received 52% positive response
ü

ü 41% of the respondents said that they experience

extensive tearing, excessive weakness and
dizziness which are signs of carbamate toxicity and
 Interpretation
 The responses from other toxicants were not
as significant as that with hypochlorite,
strychnine, carbamates and sodium perborate


ü 38% of the respondents showed signs of

pyrethrum toxicity
ü 34% of the respondents showed signs of toxicity
with camphor
ü 31% of the respondents showed signs of toxicity
with fluorides
ü 21% of the respondents showed signs of toxicity
with organophosphates, sodium
monofluoroacetate and sulphites
ü 7% of the respondents showed signs of toxicity
with diquat, organochlorines and oxalic acid
Respondents Predisposed to Other Types of
Toxicants
Interpretation
 The respondents were also asked about
their vices in order to determine
whether they were also predisposed to
intoxication with other agents aside
from the pre-identified poisons


 The results of the survey show that

majority of the respondents were
neither alcoholics nor smokers
Discussion of Results
Discussion
 As observed from the gathered data at the
National Park Development Committee:
Children’s Playground at T.M. Kalaw St.,
Ermita, Manila, the possible toxicants that
are present in the area are hypochlorites,
strychnine, carbamates, and sodium
perborate. Due to the escalation of
pesticide use, the uncontrolled application
of various cleaning agents, and their
inappropriate storage and disposal, visitors
who often go to the playground and stay
there for a long period of time with their
families or friends become exposed to
acute toxicities of these agents. Employees
who take care of the said area are more
exposed, since they are the ones utilizing
 In the study, considerable toxicity
(greater than 40%) has been seen in the
employees of the park and on some of
the perennial visitors. Eye and throat
irritation, excessive tearing and
weakness, and peeling of the skin in the
palm, soles or buttocks are some of the
signs and symptoms experienced by the
workers and visitors interviewed. There
are also other signs of toxicities found in
the area but they are not as prevalent
as the four mentioned above.

Conclusion and
Recommendations
 Proper use, handling and disposal of these
agents should be implemented strictly by
administrations of different recreational
parks for the health safety of the general
public visiting these places. Employees
should be well-informed or properly
educated on these chemicals, and how
these would affect the public health. They
also have to ensure easy access to first
aids on these chemicals (if applicable), in
case acute poisoning from these chemicals
occurs. Substitution to other cleaning
alternatives that incur less or no toxicity
may also be endorsed to the park