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Hemodialysis clearance of glyphosate following a life-threatening ingestion of glyphosate-surfactant herbicide.
- Source :
-
Clinical toxicology (Philadelphia, Pa.) [Clin Toxicol (Phila)] 2014 Jan; Vol. 52 (1), pp. 66-71. - Publication Year :
- 2014
-
Abstract
- Context: Ingestion of glyphosate-surfactant herbicides (GlySH) can result in acute kidney injury, electrolyte abnormalities, acidosis, cardiovascular collapse, and death. In severe toxicity, the use of hemodialysis is reported, but largely unsupported by kinetic analysis. We report the dialysis clearance of glyphosate following a suicidal ingestion of a glyphosate-containing herbicide.<br />Case Details: A 62-year-old man was brought to the emergency department (ED) 8.5 h after drinking a bottle of commercial herbicide containing a 41% solution of glyphosate isopropylamine, in polyoxyethyleneamine (POEA) surfactant and water. He was bradycardic and obtunded with respiratory depression necessitating intubation and mechanical ventilation. Initial laboratory results were significant for the following: pH, 7.11; PCO2, 64 mmHg; PO2, 48 mmHg; potassium, 7.8 mEq/L; Cr 3.3, mg/dL; bicarbonate, 22 mEq/L; anion gap, 18 mEq/L; and lactate, 7.5 mmol/L. Acidosis and hyperkalemia persisted despite ventilation and fluid resuscitation. The patient underwent hemodialysis 16 h post ingestion, after which he demonstrated resolution of acidosis and hyperkalemia, and improvement in clinical status. Serum glyphosate concentrations were drawn prior to, during, and after hemodialysis. The extraction ratio and hemodialysis clearance were calculated to be 91.8% and 97.5 mL/min, respectively.<br />Discussion: We demonstrate the successful clearance of glyphosate using hemodialysis, with corresponding clinical improvement in a patient with several poor prognostic factors (advanced age, large volume ingested, and impaired consciousness). The effects of hemodialysis on the surfactant compound are unknown. Hemodialysis can be considered when severe acidosis and acute kidney injury complicate ingestion of glyphosate-containing products.
- Subjects :
- Acidosis chemically induced
Blood Chemical Analysis
Electrocardiography
Glycine pharmacokinetics
Glycine poisoning
Hemodynamics physiology
Humans
Hyperkalemia chemically induced
Male
Middle Aged
Respiration, Artificial
Respiratory Insufficiency chemically induced
Respiratory Insufficiency therapy
Suicide, Attempted
Unconsciousness chemically induced
Glyphosate
Glycine analogs & derivatives
Herbicides pharmacokinetics
Herbicides poisoning
Renal Dialysis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1556-9519
- Volume :
- 52
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical toxicology (Philadelphia, Pa.)
- Publication Type :
- Academic Journal
- Accession number :
- 24400933
- Full Text :
- https://doi.org/10.3109/15563650.2013.870344