Glyphosate herbicides, which are widely used worldwide, are known to have low toxicity. However, excessive intake may cause serious life-threatening complications; therefore, caution is needed when using them. A 51-year-old man visited the hospital after ingesting glyphosate herbicide. At the time of admission, his vital signs were 80/60 mmHg-115/min-20/min-37.3℃. Electrocardiogram (ECG) showed QRS widening and corrected QT (QTc) prolongation, and blood tests showed metabolic acidosis. Treatment with gastric lavage, activated charcoal, sodium bicarbonate and intravenous lipid emulsion therapy was performed. After 2 hours, his blood pressure increased to 130/90 mg, and no QRS widening was observed on ECG.
Acidosis ; Blood Pressure ; Charcoal ; Electrocardiography ; Gastric Lavage ; Hematologic Tests ; Herbicides ; Humans ; Middle Aged ; Poisoning ; Sodium Bicarbonate ; Vital Signs

PURPOSE: Glyphosate herbicides (GHs) are widely used and increasingly associated with poisoning cases. Acute pancreatitis (AP) is among the many complications associated with the toxicity of GHs. We investigated the relationship between incidence of AP and its prognosis in patients with GH poisoning. METHODS: This was a retrospective cohort study conducted at a single tertiary hospital between January 2004 and December 2014. We enrolled all patients presented to the emergency department with GH poisoning. The Clinical and laboratory variables were analyzed to investigate the relationship between GH intoxication and AP. RESULTS: We studied 245 patients. Incidence of AP after GH poisoning was 6.5%. Patients with AP (mean 66 years) were older than the non-AP group (56 years). Systolic blood pressure, Glasgow Coma Scale, and amount of ingested poison differed significantly between the two groups. In the blood tests, white blood cell count, alanine aminotransferase, glucose, potassium, amylase, and lipase showed significant differences. The pH, bicarbonate, and lactate levels also differed significantly. Patients with AP demonstrated higher incidence of respiratory failure, pneumonia, acute kidney injury, rhabdomyolysis, and intensive care unit stay time. Additionally, 30-day mortality (n=11, 68.8%) was significantly higher in the AP group. On multivariate analysis, adjusted age, amount of ingestion, and lactate correlated with occurrence of AP. CONCLUSION: The incidence of GH-induced AP was 6.5% with a 30-day mortality of 68.8%. The patient's age, ingested dosage, and lactate levels were associated with GH-induced AP.
Acute Kidney Injury ; Alanine Transaminase ; Amylases ; Blood Pressure ; Cohort Studies ; Eating ; Emergency Service, Hospital ; Glasgow Coma Scale ; Glucose ; Hematologic Tests ; Herbicides ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intensive Care Units ; Lactic Acid ; Leukocyte Count ; Lipase ; Mortality ; Multivariate Analysis ; Pancreatitis* ; Pneumonia ; Poisoning ; Potassium ; Prognosis* ; Respiratory Insufficiency ; Retrospective Studies ; Rhabdomyolysis ; Tertiary Care Centers

Amylases ; blood ; Herbicides ; poisoning ; Humans ; Lipase ; blood ; Paraquat ; poisoning ; Poisoning ; blood

Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.
Acute Kidney Injury/*diagnosis/pathology/therapy ; Antioxidants/therapeutic use ; Creatinine/blood ; Hemoperfusion ; Herbicides/*poisoning ; Humans ; Iron Chelating Agents/therapeutic use ; Lung Diseases/*diagnosis/pathology/therapy ; Paraquat/blood/*poisoning/urine ; Tomography, X-Ray Computed

PURPOSE: Glyphosate is widely used and its toxic exposures are not rare. Occasionally, glyphosate intoxication can lead to death. The aim of this study is to analyze clinical findings and fatality in glyphosate intoxication. METHODS: Clinical data on acute glyphosate intoxication were prospectively collected at 28 hospitals nationwide between August 2005 and July 2006. The patients' clinical symptoms and characteristics of fatalities were investigated and statistical analysis was performed. RESULTS: Among 105 patients who were finally included, gastrointestinal symptoms(59%) were the most common. A significant difference in the amount ingested was observed between patients with higher systolic blood pressure and those with systolic blood pressure less than or equal to 80 mmHg (p<0.001). The more the patients ingested, the more aggravated their mental status became (p=0.004). Seven patients(6.7%) died, and all of them had ingested greater than or equal to 200 ml. Patients who died had ingested greater amounts than the survivors (p<0.001), and their mental status was worse (p<0.001), and systolic blood pressure was lower (p<0.001). According to the result of logistic regression analysis, relative risk was 24.1-fold higher in the 'poor' mental status group compared with 'good'. CONCLUSION: Patients who ingested large amounts of glyphosate showed poor mental status and lower blood pressure. Statistical difference in amount ingested, mental status, and systolic blood pressure was observed between survivors and patients who died. Ingested amounts and mental status were the most important factor of the prognosis of glyphosate intoxication.
Blood Pressure ; Herbicides ; Humans ; Logistic Models ; Poisoning ; Prognosis ; Prospective Studies ; Survivors

Chloracetanilide herbicides (alachlor, butachlor, metachlor) are used widely. Although there are much data about chronic low dose exposure to chloracetanilide in humans and animals, there are few data about acute chloracetanilide poisoning in humans. This study investigated the clinical feature of patients following acute oral exposure to chloracetanilide. We retrospectively reviewed the data on the patients who were admitted to two university hospitals from January 2006 to December 2010. Thirty-five patients were enrolled. Among them, 28, 5, and 2 cases of acute alachlor, metachlor, butachlor poisoning were included. The mean age was 49.8 +/- 15.4 yr. The poison severity score (PSS) was 17 (48.6%), 10 (28.6%), 5 (14.3%), 2 (5.7%), and 1 (2.9%) patients with a PSS of 0, 1, 2, 3, and 4, respectively. The age was higher for the symptomatic patients (1-4 PSS) than that for the asymptomatic patients (0 PSS) (43.6 +/- 15.2 vs 55.7 +/- 13.5). The arterial blood HCO3 was lower in the symptomatic patients (1-4 PSS) than that in the asymptomatic patients (0 PSS). Three patients were a comatous. One patient died 24 hr after the exposure. In conclusion, although chloracetanilide poisoning is usually of low toxicity, elder patients with central nervous system symptoms should be closely monitored and cared after oral exposure.
Acetamides/*poisoning ; Acetanilides/*poisoning ; Acute Disease ; Adult ; Aged ; Bicarbonates/blood ; Central Nervous System Diseases/diagnosis ; Female ; Herbicides/*poisoning ; Humans ; Male ; Middle Aged ; Poisoning/*diagnosis ; Retrospective Studies ; Severity of Illness Index ; Suicide, Attempted

OBJECTIVETo observe the effects of hemoperfusion on plasma concentration and histopathological changes in paraquat (PQ) poisoning rabbits.

METHODSSixteen rabbits were randomly divided into exposure group (PQ group, n = 8) and hemoperfusion plus PQ exposure group (HPQ group, n = 8). HPQ group were given hemoperfusion in 45 min after exposure to PQ. The plasma PQ concentrations at 0.5, 1.0, 1.5, 2.0, 3.0, 6.0, 12.0, 24.0, 48.0 and 72.0 hours after exposure were measure in 2 groups. The histopathological changes of lung, liver and kidney were examined, the behavior changes and the survival number of 7 days were observed.

RESULTSThe poisoning symptoms of HPQ group were generally better than those of PQ group, in each group six animals survived for 7d. The plasma PQ concentrations at 1.0, 1.5, 2.0, 3.0, 6.0, 12.0, 24.0, 48.0, 72.0 h after exposure in HPQ group were significantly lower than those in PQ group (P < 0.05 or P < 0.01). In HPQ group, the plasma PQ peak concentration [(5.01 ± 0.15] µg/L], area under the curve [(54.03 ± 5.31) mg×h(-1)×L(-1)] and PQ half-life time [(16.29 ± 3.26) h] after treatment of HP were significantly lower than those [(11.97 ± 0.75) µg/L, (141.40 ± 10.10) mg×h(-1)×L(-1) and (31.16 ± 9.85) h] in PQ group (P < 0.05). The apparent volume of distribution and PQ clearance rate in HPQ group were significantly higher than those in PQ group (P < 0.05). Congestion, edema, cell infiltration and other pathological changes were found in lung, liver and kidney in PQ group under the light microscope, which were significantly more severe than those in HPQ group. The pathologic scores of lung tissue, liver and renal tubular damage on the 1st, 3rd, 7th days after exposure in HPQ group were significantly lower than those in PQ group (P < 0.05).

CONCLUSIONWhen acute PQ poising, rabbits appeared the quick absorption, high toxicity and long half-life time of PQ. The early hemoperfusion can effectively remove the toxicant in plasma and reduce the pathological injury in major organs, which may be beneficial for further treatment.

Animals ; Area Under Curve ; Female ; Hemoperfusion ; Herbicides ; blood ; poisoning ; Kidney ; pathology ; Liver ; pathology ; Lung ; pathology ; Male ; Paraquat ; blood ; poisoning ; Rabbits

To investigate the effects of reactive oxygen species (ROS) on tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) plasma levels, and their possible implications on clinical outcome, we measured tPA and PAI-1 levels in 101 patients with acute paraquat (PQ) intoxication. The control group consisted of patients who ingested non-PQ pesticides during the same period. tPA and PAI-1 levels were higher in the PQ group than in the controls. PQ levels were significantly correlated with ingested amount, timelag to hospital, tPA level, and hospitalization duration. tPA levels were correlated with PAI-1, fibrin degradation product (FDP), and D-dimer. D-dimer levels were lower in the PQ group than in the controls. Univariate analysis indicated the following significant determinants of death: age, ingested amount, PQ level, timelag to hospital, serum creatinine, lipase, pH, pCO2, HCO3-, WBC, FDP, PAI-1, and tPA. However, multivariate analysis indicated that only PQ level was significant independent factor predicting death. In conclusion, tPA and PAI-1 levels were higher, while D-dimer levels were lower in the PQ group than in the controls, implying that ROS stimulate tPA and PAI-1, but PAI-1 activity overrides tPA activity in this setting. Decreased fibrinolytic activity appears to be one of the clinical characteristics of acute PQ intoxication.
Acute Disease ; Adult ; Aged ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Herbicides/blood/*poisoning ; Humans ; Male ; Middle Aged ; Paraquat/blood/*poisoning ; Plasminogen Activator Inhibitor 1/*blood ; Reactive Oxygen Species/metabolism ; Risk Factors ; Tissue Plasminogen Activator/*blood ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Based on preliminary in vitro data from a previous study, we proposed that 50 mg/kg glutathione (GSH) would be adequate for suppressing reactive oxygen species in patients with acute paraquat (PQ) intoxication. METHODS: Serum levels of reactive oxygen metabolites (ROM) were measured before and after the administration of 50 mg/kg GSH to each of five patients with acute PQ intoxication. RESULTS: In one patient, extremely high pretreatment ROM levels began to decrease prior to GSH administration. However, in the remaining four cases, ROM levels did not change significantly prior to GSH administration. ROM levels decreased significantly after GSH administration in all cases. In two cases, ROM levels decreased below that observed in the general population; one of these patients died after a cardiac arrest at 3 hours after PQ ingestion, while the other represented the sole survivor of PQ intoxication observed in this study. In the survivor, ROM levels decreased during the first 8 hours of GSH treatment, and finally dropped below the mean ROM level observed in the general population. CONCLUSIONS: Treatment with 50 mg/kg GSH significantly suppressed serum ROM levels in PQ-intoxicated patients. However, this dose was not sufficient to suppress ROM levels when the PQ concentration was extremely high.
Adult ; Aged ; Antioxidants/administration & dosage ; Case-Control Studies ; Fatal Outcome ; Glutathione/*administration & dosage ; Herbicides/administration & dosage/poisoning ; Humans ; Male ; Middle Aged ; Paraquat/administration & dosage/*poisoning ; Pilot Projects ; Reactive Oxygen Species/*blood ; Time Factors ; Treatment Outcome

The mortality rate of acute paraquat (PQ) poisoning depends on the PQ concentration in the blood. It has been shown that the kidneys eliminate PQ effectively. However, early renal function deterioration is frequently observed in acute PQ intoxication. This study is designed to compare the efficacy of PQ elimination with hemoperfusion (HP) and kidneys, taking into account the functional deterioration of the kidneys. The amount of renal and HP excretion of PQ were measured during the procedure of HP in patients with acute PQ intoxication. The PQ clearance and the actual amount of PQ elimination by the HP cartridge during the HP procedure were 111+/-11 mL/min (range; 13.2-162.2 mL/min) and 251.4+/-506.3 mg (range; 4.6- 1,655.7) each. While, the renal clearance and actual amount of renal elimination of PQ was 79.8+/-56.0 mL/min (range; 9.7-177.0) and 75.4+/-73.6 mg (range; 4.9- 245.8). As the creatinine clearance decreased, the PQ elimination by HP was as effective as or more effective than the renal elimination. In conclusion, early HP must be provided for life saving treatment in patients with acute PQ intoxication.
Adult ; Aged ; Creatinine/blood ; Emergency Medicine/methods ; Female ; Hemoperfusion/*methods ; Herbicides/*poisoning ; Humans ; Kidney/drug effects/physiology ; Male ; Middle Aged ; Overdose/therapy ; Paraquat/*poisoning ; Renal Dialysis/*methods ; Suicide