# Paraquat Dichloride Ingestion Risk Message for Pesticide

ApplicatorsO n December 24, 2014 , the EPA distributed the following paraquat safety message and slides to the EPA ’ s listserv of pesticide safety applicators with the message below :

From: Fitz, Nancy S ent: Wednesday, December 24, 2014 8:45 AM To: AAPSE@LISTSERV.VT.EDU Subject: Ingestion risk from paraquat dichloride

Good morning,

This message is not ex actly full of holiday cheer but includes important information. I am writing to ask for your help in warning the pesticide applicator community about the high toxicity of paraquat dichloride and the need to prevent accidental ingestions. We would really appreciate it if you could share this information with your colleagues and incorporate it into your training sessions over the next few months. I have included a 2.5

- page Word document with the information as well as a few draft PowerPoint slides for your convenience.

The attached Word document describes the findings of a recent EPA incident investigation, where we found cases of eight deaths due to the accidental ingestion of paraquat dichloride. All eight accidental deaths involved the transfer of para quat dichloride into a beverage container.

As you well know, the Core Manual includes instructions to never store pesticides in beverage or other food containers. The labels of paraquat clearly state “NEVER PUT INTO FOOD, DRINK OR OTHER CONTAINERS.” Yet this happens occasionally, which can lead to tragic results. The goal of providing this information to you all (and then to pesticide applicators) is to give some real

- life examples that demonstrate WHY pesticide applicators should not store pesticides i n beverage or food containers.

If you have any questions about this information, please email or call me. I am in the office today and will be available next week on Tuesday (December 30) and Friday (January 2).

Nancy Fitz Office of Pesticide Programs U.S. Environmental Protection Agency phone: 703

- 305

- 7385 email: fitz. nancy@epa.gov web site: http://www.epa.gov/pesticides/regulating/containers.htm

## Paraquat Dichloride Ingestion Risk Message for Pesticide Applicators

Paraquat Dichloride: One Sip Can Kill.

The Accidental Poisoning Problem The California Poison Control System and the Central California Children’s Hospital reviewed data from 1998

- 2009 and identified more than 1,400 cases of accidental poisonings caused by storage of non

- food substances in soda bottles, unmarked bottles, cups or glasses. Several of the deaths involved the accidental inges tion of pesticides, including paraquat. 1

Recent Deaths from the Accidental Ingestion of Paraquat The California Poison Control System and the American Association of Poison Control Centers (AAPCC) recently sent letters of concern to EPA regarding a serie s of deaths from accidental ingestion of the pesticide paraquat in the San Joaquin Valley of California. AAPCC cited 50 deaths from paraquat; at least 12 were from accidental ingestion of paraquat from a beverage container.

This is a major concern to EPA because paraquat is a Restricted Use Pesticide that should not be accessible to the general public and, as with all pesticides, should never be placed into a beverage container. P araquat is highly toxic to humans; o ne small accidental sip can be fatal and there is no antidote

. The product labels clearly prohibit pouring paraquat into food or beverage containers with the prominently

- placed statements “NEVER PUT INTO FOOD, DRINK OR OTHER CONTAINERS” and “DO NOT REMOVE CONTENT S EXCEPT FOR IMMEDIATE USE.”

Paraquat Use Profile Paraquat dichloride , commonly referred to as “paraquat

, ” is an herbicide registered in the U nited S tates since 1964 to control weeds in many agricultural and non

- agricultural use sites. It is also applied as a pre

- harvest desicca nt on some crops including cotton.

All paraquat products registered for use in the U nited S tates are Restricted Use P esticides (RUP s )

, which can only be sold to and use d by certified applicators (and applicators under their direct supervision) . T here are no homeowner uses and no products registered for application in residential areas

.

1 Epidemiology of Accidental Poisoning Caused by Storage of Non

- Food Substances in Food Containers and unmarked Bottles/Containers. Geller RJ, Kezirian R, Bangar P, Strong D, Carlson T. Children’s Hospital Central California; California Poison Control Syste m (CPCS). Found online at: http://informahealthcare.com/doi/pdf/10.1080/15563650903076924

## Paraquat Dichloride Ingestion Risk Message for Pesticide Applicators

EPA Incident Investigation The fatalities resulting from paraquat products transferred into beverage containers in California prompted EPA to investigate all reported cases. EPA conducted an investigation of all reports of fatal and high

- severity paraquat incidents. EPA i dentified 27 paraquat fatality reports to date in its Incident Data System (IDS) . The IDS database contains all registrant submissions of adverse health effects from pesticide products, as required by federal law ( FIFRA § 6 ( a ) ( 2 ) ) . More than 80% of all identified paraquat fatalit y cases reported to IDS were due to ingestion of the product

.

At least e ight of these 27 deaths were due to the accidental ingestion of paraquat . A ll eight of these accidental deaths involved transfer of paraquat into a beverage contain er

. Several of these cases have occurred recently. A revie w of the SENSOR

- Pesticides data identified additional ingestion cases, including the fatal case of an 8

- year

- old child who drank the paraquat out of a soda bottle.

True Stories
In 2013, a 70

- year

- old female ingested some contents of a re

- used iced tea bottle that contained paraquat , unknown to her. She went to the hospital awake and alert with persistent vomiting. Over the course of a 16

- day admission, she evolved the classic picture of paraquat ingestion: corrosive gastrointestinal injury plus kidney and respiratory failure leading to death.
In 2010, a 44

- year

- old male mistakenly drank paraquat, which he thought was fruit juice. He developed difficulty breathing and vomited blood. He was admit ted to the hospital intensive care unit where he died after 20 days of aggressive treatment.
In 2008, a n 8

- year

- old boy drank paraquat that had been put in a Dr. Pepper bottle , which he found on a window sill in the garage. He died in the hospital 16 day s later. H is older brother had used the product on weeds ar ound the house and put it in the bottle in the garage . The

o lder brother obtained the product from a family friend who is a certified Restricted Use P esticide applicator.
In 2003, a 49

- year

- old male took a sip from his coffee cup in which he had poured paraquat because the product’s bottle was deteriorating. He realized his mistake and went to the Emergency Department . At that time, he was vomiting, cold and sweating profusely . Doses of ac tivated charcoal were administered and his stomach was pumped ; morphine was provided for esophageal pain; and he was intubated to support breathing function on the fourth day. Aggressive supportive care continued until he died on the tenth day.
In 2000, a 15

- month

- old boy ingested paraquat that had been transferred into a Gatorade container and stored inappropriately

. The boy survived in the hospital for 13 days after the ingestion and received aggressive treatment but died after suffer ing a cute kidney and liver failure

. In 2000, a n 18

- month

- old boy ingested an unknown amount of paraquat solution from a bottle found in his father’s landscaping truck . He received multiple

- dose activated charcoal treatment two hours after the ingestion. H e suffered from lack of oxygen during the first 24 hours followed by progressive liver

, kidney , an d cardio

- pulmonary dysfunction. The boy died 11 days after the ingestion

.

## Paraquat Dichloride Ingestion Risk Message for Pesticide Applicators

EPA Response While EPA determines the appropriate regulatory response, we want to warn the applicator community about the high toxicity of paraquat.

It is the responsibility of pesticide applicators to ensure that RUP products are used safely and appropriately, including never transferring any pesticide product, including paraquat, into a beverage container.

The Solution is YOU

ONE SIP CAN KILL !

To prevent the severe injury and/or death from paraquat ingestion, a paraquat product must:

• Be used only by a certified applicator or under the direct supervision of a certified applicator ;

• N ever be transferred to a food, drink or any other co nt ainer ;

• A lways be kept secured to prevent access by children and/or other unauthorized persons ;

• N ever be stored in or around residential dwellings ; and

• N ever be used around home gardens, schools, recreational parks, golf course s or playgrounds

. Paraquat Dichloride Information Resources

• EPA’s Paraquat Dichloride Registration Rev iew Docket, EPA

- HQ

- OPP

- 2011

- 0855, for information on EPA’s current re

- evaluation of paraquat. This docket includes a letter from Dr. Gellar ( California Poison Control System ) , the EPA response, and the AAPCC letter. http://www.regulations.gov/#!docketDetail;D=EPA

- HQ

- OPP

- 2011

- 0855

• Syngenta’s Paraquat Information Center: www.paraquat.com/safety

# Paraquat Dichloride:

One Sip Can Kill !

# Deaths from Accidental Ingestion of Paraquat

 

# Several accidental paraquat ingestion deaths have occurred in recent years.

 

# EPA looked into these deaths and found that such cases often occur as a result of the pesticide being transferred into a beverage container.

 

# This is a major concern to EPA because paraquat is a Restricted Use Pesticide and, like all pesticides, should never be placed into a beverage container.

 

# Paraquat is highly toxic to humans; one small accidental sip is often fatal and there is no antidote.

# Deaths from Accidental Ingestion of Paraquat

 

# The product labels clearly prohibit pouring paraquat into food or beverage containers with the prominently

placed statements:

“ NEVER PUT INTO FOOD, DRINK OR OTHER CONTAINERS .”

“ DO NOT REMOVE CONTENTS EXCEPT FOR IMMEDIATE USE .”

# True Stories

 

# In 2008, an 8

- year old boy drank paraquat that had been put in a Dr. Pepper bottle , which he found on a window sill in the garage. He died in the hospital 16 days later . His older brother had used the product on weeds around the house and put it in the bottle in the garage. The older brother obtained the product from a family friend who is a certified Restricted Use Pesticide applicator.

# True Stories

In 2003, a 49

- year old male took a sip from his coffee cup in which he had poured paraquat herbicide because the product’s bottle was deteriorating. He realized his mistake and went to the Emergency Department. At that time, he was vomiting, cold and sweating profusely.
Doses of activated charcoal were administered and his stomach was pumped; morphine was provided for esophageal pain; and he was intubated to support breathing function on the fourth day. Aggressive supportive care continued until he died on the tenth day

.

# True Stories

 

# In 2000, a 15

- month old boy ingested paraquat product that had been transferred into
a Gatorade container and stored inappropriately. The boy survived in the hospital for 13 days after the ingestion and received aggressive treatment, but died after suffering acute kidney and liver failure.  

# In 2000, an 18

- month old boy ingested an unknown amount of paraquat solution from a bottle found in his father’s landscaping truck. He received multiple

- dose activated charcoal treatment two hours after the ingestion. He suffered from lack of oxygen during the first 24 hours followed by progressive liver, kidney, and cardio

- pulmonary dysfunction. The boy died 11 days after the ingestion

.

# Applicators: The Solution is You!

To prevent the severe injury and/or death from paraquat ingestion, a paraquat product must:

 

# Be used only by a certified applicator or under the direct supervision of a certified applicator.

 

# Never be transferred to a food or drink container

.  

# Always be kept secured to prevent access to children and/or other unauthorized persons.

 

# Never be stored in or around residential dwellings.

 

# Never be used around home gardens, schools, recreational parks, golf courses or playgrounds.