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glyphosate is a non - selective herbicide , widely used in agriculture , forestry , industrial weed control and aquatic environments .
proposed mechanisms of glyphosate surfactant herbicide ( glysh ) toxicity to mammals include uncoupling of oxidative phosphorylation and glyphosate - or polyethoxethyleneamine ( poea)-mediated direct cardiotoxicity .
it can cause a wide range of clinical manifestations in human beings from skin and throat irritation to hypotension and death .
this was a case report of a 35-year - old male patient who brought to our hospital with intentional ingestion of approximately 200 ml of glyphosate ( herbicide ) at around 10:15 am at home . later
( after 15 m ) when the family members recognized the consumption , he was taken immediately to a local hospital where gastric lavage was done and subsequently shifted to our multispecialty hospital . in the casualty the patient was conscious and obeying commands .
on examination the patient was afebrile , pulse rate : 110/m , blood pressure ( bp ) : 94/60 mm hg , spo2 - 97% , glasgow coma scale 15/15 , cardiovascular , respiratory and gastrointestinal systems were normal . the patient was initially stabilized with intravenous ( iv ) fluids in casualty and later shifted to the intensive care unit for further management .
routine blood investigations were as follows : hb% : 14.9 g / dl , total leucocyte count ( tlc ) 18,600 and platelet count : 2.9 lakh cells / cu mm .
serum creatinine : 2.1 mg / dl , blood urea : 44 mg / dl , serum sodium : 148 meq / l , potassium : 6.5 meq / l , chloride : 101 meq / l .
total bilirubin : 0.6 mg / dl , sgot-11 u / l , sgpt-67 u / l , serum albumin : 5.3
g / l . arterial blood gas analysis : p : 7.2 , pco2:31 , po2 : 171 , hco3:12.2 .
sequential organ failure assessment score : 4 and acute physiology and chronic health evaluation score : 16 .
he received calcium gluconate 1 g ( 10 ml ) iv , dextrose - insulin infusion along with salbutamol nebulization for hyperkalemia .
after 6 h of admission continuous veno - venous hemodiafiltration started in view of severe acidosis , hyperkalemia and raised creatinine levels .
after 10 h of ingestion patient had sudden respiratory distress along with hypotension and was hence intubated and ventilated .
for hypotension after adequate fluid resuscitation with central venous pressure of 9 - 10 mm hg ( also using ultrasound guided - inferior venacaval collapsibility / distensibility ) , noradrenalin infusion started at 0.05 mcg / kg / min .
after 24 h , the patient was febrile , heart rate ( hr ) : 160 beats / min , bp : 90/60 mm hg ( with high noradrenalin : 3 mcg / kg / min and vasopressin : 0.04 u / min ) anuric , procalcitonin : > 10 and serum lactate : 37.5 mg / dl ( reference value 4 - 20 mg / dl ) , serum creatinine 6.1 mg / dl and tlc-13,000 cells / cumm . patient was started on empirical antibiotic meropenem .
iv lipid emulsion ( 20% intralipid 100 ml ) once daily for three consecutive days ( which started from 2 day ) . on 4 day patient improved hemodynamically with hr : 90 beats / min , bp : 120/78 mm hg with minimal inotropic support .
tlc : 7800 , serum potassium : 3.5 meq / l , serum creatinine : 3.5 mg / dl , p : 7.42 , pco2:35.6 and po2:145 .
the hemodynamic parameters from admission to first 5 days has been shown in table 1 .
hemodynamic parameters for first 4 days after admission sustained low efficacy dialysis was done daily for first 4 days and later on alternate days for next four dialysis and stopped in view of adequate urine output from 14 day . patient weaned from the ventilator on 4 day , later bi - level positive airway pressure support for few hours and oxygen mask for next 24 h. the inotrope and vasopressor tapered and stopped over next 24 h from day 4 .
glyphosate surfactant is a widely used herbicide in agriculture , forestry , industrial weed control , lawn , garden and aquatic environments .
it is a non - selective herbicide . in plants , glyphosate disrupts the shikimic acid pathway resulting in a deficiency of 5-enolpyruvylshikimate-3-phosphate production which leads to reductions in protein synthesis and plant growth , death of the plant occurs in 4 - 20 days .
the median half - life of glyphosate in soil is between 2 and 197 days . in humans
the mechanism of toxicity of glyphosate in mammals is thought to be uncoupling of oxidative phosphorylation .
the acute oral lethal dose ( ld50 ) in rats is > 4320 mg / kg , dermal ld50 is > 2 g / kg and inhalation lethal concentration 50 is > 4.43 mg / l .
after oral ingestion of glyphosate 30 - 36% is absorbed , peak concentrations occurs in tissues 6 h following dosing , undergoes little metabolism and is excreted mostly unchanged in the feces and secondarily in the urine .
inhalation of spray mist may cause oral / nasal discomfort , tingling and throat irritation .
severe poisoning causes dehydration , hypotension , pneumonitis , oliguria , altered level of consciousness , hepatic dysfunction , acidosis , hyperkalemia and dysrhythmias .
it has not been determined whether these clinical features reflect primary ( direct ) or secondary ( indirect ) toxic effects of these herbicide formulations .
patients developing acute kidney injury , hyperkalemia , pulmonary edema and metabolic acidosis are more likely to die .
early renal replacement therapy may improve prognosis but there is no evidence to support this and requires identification of those at risk .
there is no antidote for glysh and treatment is supportive . the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy .
gastric lavage or activated charcoal can be administered in patients who present < 1 h after ingestion and who have no evidence of buccal irritation or burns .
there is no evidence , however , that either of these reduce the systemic absorption of glysh .
intravenous fat emulsion ( ife ) has been used in the management of severe local anesthetic toxicity , calcium channel blockers , tricyclic antidepressants and beta blockers . proposed mechanisms of glysh toxicity to mammals
a study by han et al . demonstrated the effectiveness of ife in severe poisoning patient who was refractory to inotropic support later showed recovery after administration of ife , surviving to hospital discharge without further sequelae .
the mechanism of action of ife may be due to the lowering of serum concentration of the free surfactant poea component of glysh ( which are more lipophilic ) by dragging into the lipid sink formed by the ife , thereby blunting its cardiovascular toxicity .
glyphosate exposure can be measurement in blood or urine by gas chromatography and high - performance liquid chromatography .
glyphosate is a widely used herbicide in agriculture , forestry , industrial weed control and aquatic environments . 
 glyphosate potential as herbicide was first reported in 1971 . 
 it is a non - selective herbicide . 
 it can cause a wide range of clinical manifestations in human beings like skin and throat irritation to hypotension , oliguria and death . 
 we are reporting a case of a 35-year - old male patient who was admitted to our tertiary care hospital following intentional ingestion of around 200 ml of herbicide containing glyphosate . 
 initially , gastric lavage done and the patient was managed with intubation and mechanical ventilation , noradrenaline and vasopressin infusion , continuous veno - venous hemodiafiltration and intravenous ( iv ) lipid emulsion ( 20% intralipid 100 ml ) , patient was successfully treated and discharged home . 
 this case report emphasizes on timely systemic supportive measure as a sole method of treatment since this poison has no known specific antidote and the use of iv lipid emulsion for a successful outcome .