Fatal poisoning with glyphosate-surfactant herbicide

Abstract

A 29-year-old man was admitted following deliberate ingestion of approximately 300 mL of 'Roundup Ace,' a herbicide containing glyphosate. On presentation, he was agitated and required intubation and admission to ICU. He developed severe and persistent lactic acidosis, hyperkalaemia, hypotension, torrential watery diarrhoea and abdominal distension in the first 24 hours. The patient was supported with a continuous noradrenaline infusion and continuous veno-venous haemodiafiltration. The clinical course was further complicated by cardiac arrhythmias and an episode of cardiac arrest. By day three, he had bone-marrow, liver and worsening respiratory failure. There was no hope of recovery; therefore, noradrenaline was discontinued, and the patient died 15 minutes later. Glyphosate-surfactant herbicide (GlySH) is a general-purpose herbicide with no anticholinesterase effect and no organophosphate-like CNS effects. GlySH intoxication has a case fatality rate of between 3.2% and 29.3%. There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. Early renal replacement therapy may improve prognosis but there is no evidence to support this. There is one published case of a patient who survived severe GlySH poisoning following administration of intravenous fat emulsion. Glyphosate-surfactant herbicide, commercially known as 'Roundup' is a widely available herbicide commonly used in both professional and domestic settings. This is a case of a young man who deliberately ingested GlySH at home and rapidly developed multi-organ failure, culminating in his death.© The Intensive Care Society 2011.