Other Routes of Exposure

Skin

• If the product is used as recommended and normal hygiene practices are observed, effects on the skin are unlikely. Intact skin is an effective barrier to paraquat absorption under normal circumstances.
• Local Effects
  - concentrated formulations (e.g. 'Gramoxone 100') may result in irritation, blistering and potentially full thickness burns which usually develop 1 to 3 days after exposure.
  - brief contact with products diluted for use may cause erythema.
  - nail damage, discoloration (e.g. white spots) or total loss of the nail may occur upon direct contact with the concentrated formulation. Normal nail regrowth follows
• Systemic toxicity is rare but can occur if there is:
  - prolonged contact e.g. not washing after being splashed with concentrate; carrying of leaking knapsack sprayers; wearing of clothes soaked in spray.
  - Extensive scrotal or perineal contamination.
  - skin is broken and there is significant exposure.
  - large areas of skin contaminated with concentrate, even if washed.

Prevention and treatment

• Decontaminate as soon as possible by removing contaminated clothes and washing skin thoroughly with soap and copious amounts of water, taking care to avoid abrasion.
• Treat any skin irritation/damage symptomatically with daily review if contaminated with concentrate (as blistering and chemical burns may develop over 1 to 3 days).
• If systemic toxicity is suspected, test urine for paraquat. There is little data for time to peak plasma levels by skin absorption, but if the urine is negative for 24 hours, systemic toxicity can probably be discounted. If the urine test is positive or if there is any doubt about potential systemic toxicity, obtain a blood level and treat for systemic toxicity as above

Eyes

• Spray dilutions
  - may cause a transient stinging sensation but no damage is expected.
• Formulations concentrates
  - may cause severe inflammation of the cornea and conjunctiva which may gradually develop over 24 hours.
  - loss of corneal and conjunctival epithelium and even mild iritis can occur with the risk of secondary infection and consequent residual corneal scarring.
  - corneal oedema may persist for up to 3-4 weeks with temporary blurring of vision.

Treatment

• The eye should be irrigated immediately for at least fifteen minutes with water or saline and a fluorescein stain performed.
• Local antibiotics may be needed to prevent secondary infection.
• If splashed with the concentrate, patients should be reviewed after 24 hours.
• Referral to an ophthalmologist should be considered.

Inhalation

• Paraquat is not volatile but all liquid Syngenta paraquat formulations contain an unpleasant 'stenching agent' which may occasionally cause feelings of nausea or headaches.

Spraying

• when applied as recommended the spray droplets are too large to be inhaled into the lungs.
• application as a fine mist may cause some irritation of the upper respiratory tract but there are no reports of serious systemic toxicity from inhalation. Local irritation of nose and throat may occasionally cause epistaxis. Contact of nasal mucosa with fingers contaminated with paraquat may also cause nose bleeds.

Treatment

No specific treatment is required other than symptomatic for epistaxis. There is no need to perform a urine test as the lungs are not a major route of absorption.