SUCCESSFUL MANAGEMENT IN OTHERWISE LETHAL SUICIDAL POISONING WITH 2,4-DICHLORPHENOXYACETIC ACID

Cristian Cobilinschi; Andrei Cosmin Andrei; Radu Tincu

doi:10.33695/rojes.v3i1.37

Cristian Cobilinschi 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 2 Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Andrei Cosmin Andrei 2 Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Radu Tincu 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 2 Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania

DOI: https://doi.org/10.33695/rojes.v3i1.37

Keywords: herbicides, 2,4-dichlorphenoxyacetic acid, acute poisoning, urine alkalinization, critical care

Abstract

Herbicides are widely used to control the growth of broadleaf plants and among these 2,4-dichlorphenoxyacetic acid (2,4-D) has become dominant in both agriculture and households. However, despite being rare, acute intoxication with 2,4-D has lethal potential if early diagnosis and management are misguided. 2,4-D poisoning can mimic OP intoxication, so neuromuscular toxicity and coma can orient towards a correct symptom identification. We report the case of a 46-year-old male patient brought into the emergency department after voluntary herbicide ingestion that family confirmed as 2,4-D. Initial assessment revealed an agitated, confused, drowsy patient with a CGS of 9. Laboratory tests revealed mild metabolic acidosis and rhabdomyolysis. Patient management included early sodium bicarbonate administration, low dose mannitol, injectable furosemide and supplemental potassium to induce urine alkalinization. He was discharged five days later in good clinical condition. Acute 2,4-D intoxication has an increased risk of mortality, especially since no antidote is available. Diagnosis should be made promptly and urine alkalinization to accelerate poison clearance is the mainstay treatment.

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