>> A'm sorrie tae hear tha Erica, whit were ye daen drinkin pesticides?
> I've been ill for 15 years, and my doctor says very few people with
> this sort of problem ever really get over it, but there's a good
> chance I'll get some sort of life back as long as I stay right away
> from toxic substances, because my system can't detoxify them as
> others' can
The usual cause of this kind of problem is organophosphates. I did some
research into this when my girlfriend (a dietitian/allergy specialist)
and the doctor she works for were treating a whole family who'd been
clobbered with the stuff. The practicalities of this kind of poisoning
aren't generally familiar, so it may be worth giving the important tip
and its rationale even though this is way OT.
Organophosphate or carbamate poisoning is basically the same as nerve
gas poisoning; the chemical locks on to the enzyme acetylcholinesterase,
which is what your nervous system uses to eliminate the neurotransmitter
acetylcholine after it has been used to send a nerve impulse. If the
acetylcholine builds up too much, nerves start firing uncontrollably or
shut down.
The poisoning goes through three stages. In the first stage, levels
of acetylcholine have built up enough to cause acute symptoms; this
may only take minutes to start. Symptoms include vomiting, blindness,
diarrhoea, muscle spasms, and paralysis; perhaps death from paralysis
of the breathing muscles. Treatment here is the sort of thing familiar
from the Gulf War: chemicals that counteract acetylcholine (atropine,
pyridostigmine). You have to keep pumping the antidote in to keep the
symptoms down. You also have to balance the antidotes carefully, as
they are all potentially lethal poisons themselves. In some cases an
iron lung may be necessary for a short time. This acute phase is over
in hours, but the problems aren't.
In the next phase, acetylcholine levels have dropped enough that you won't
die immediately, but there is still a lot of poison bound to the enzyme.
There's a blood test: it measures how much working acetylcholinesterase
there is in red cells. There is also a treatment, quite different from
the antodotes used in the acute phase. But:
*** ONLY *** ONE *** THING *** WORKS ***
- pralidoxime. This stuff dislodges the poison from the enzyme, so that
it can get back to functioning normally.
The next phase is probably where Erica is. If pralidoxime is not given
soon enough, binding of the poison to the enzyme becomes *irreversible*.
And for reasons I don't understand, the enzyme is not replaced, ever.
There's no consensus on how long you've got before this phase is reached:
I've seen 24 hours, 2 weeks and a month all quoted in different books.
Once this has happened, nerve damage is permanent and the symptoms are
chronically disabling: weakness, fatigue, mental disturbance, spasms,
pain, partial blindness. This is what happened to Marion's patients:
she could only palliate their symptoms and help them fight a compensation
case in court (they won). Big doses of nutritional supplements (e.g.
intravenous magnesium) may help to some extent.
So the bottom line is, if you have *any* reason to believe someone has
just been poisoned by organophosphates or carbamates, get in touch with a
poisons centre and find how you can get pralidoxime treatment immediately
if not sooner; your GP or A&E department will need to contact the poisons
centre themselves anyway. Pralidoxime is not very toxic so the risks are
minimal. (UK poisons centres: http://www.doh.gov.uk/npis.htm).
The same phases happen with less spectacular exposures: agricultural
workers often get this, with more and more of their acetylcholinesterase
being inactivated each time they handle sheep dip carelessly. The early
phase of this is called "dipper's flu" and does resemble flu. The later
phase can hit quite unexpectedly; if the inactivation is proceeding at a
constant rate, the syptoms won't - having enzyme activity reduced from
100% to 90% isn't like having it reduced from 20% to 10%. A weird
symptom many farmers report is suicidal impulses coming out of the blue
with no prior depressed mood: a typical case was a guy who found himself
about to drive his tractor off a cliff when he suddenly realized "what
the hell am I doing?". Since farmers typically have free access to guns,
paraquat, and lethal machinery, this may explain some of their high suicide
rate.
There is some evidence that organochlorine pesticides like DDT may increase
the risk of amyotrophic lateral sclerosis (motor neurone disease), which is
even worse. There is no way to eliminate DDT from the body and the only
treatment for ALS is a fabulously expensive drug that maybe only buys you
a few months.
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