Chemical insecticides exert their toxic action by affecting the nervous system. Toxicity may include acute, chronic, and delayed sequelae of acute exposure. The four major classes of insecticides in use today are the organophosphates, carbamates, organochlorines, and pyrethroids. Organophosphate and carbamate cholinesterase inhibitors have replaced organochlorine insecticides because of their improved effectiveness and lack of persistence in the environment and human tissues. In 1997, 70,739 insecticide exposures were reported by the American Association of Poison Control Centers. 1 Children younger than 6 years of age were involved in 30,317 of these. Of the total, 66,217 were unintentional, 13,249 were treated in health care facilities, and 2365 patients had moderate to major clinical toxicity associated with exposure. Insecticide poisoning is worldwide. In a Jordanean study of 52 patients with insecticide poisoning, mixed organophosphate and carbamate exposure was responsible in 34.5 percent and isolated organophosphate or carbamate each was responsible for 25 percent. 2

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