Emergency Medicine Book

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Glyphosate Poisoning

Aka: Glyphosate Poisoning, Glyphosate Toxicity, Glyphosate
  1. Background
    1. Glyphosate is the most commonly used herbicide in the United States (e.g. Roundup)
      1. Concentrations vary considerably (41% for commerical use, <1% for home use)
    2. Herbicides are a combination of isopropylamine (IPA) salt of Glyphosate, surfactant and other additives
  2. Mechanism
    1. Nearly all Poisoning cases are from intentional ingestion
      1. Bioavailability after ingestion: 30%
      2. Uncouples oxidative phosphorylation
      3. Cell membrane disruption
      4. Surfactant additives to the Glyphosate may cause Hypotension
    2. Skin penetration <1%
    3. Low inhalational exposure
  3. Findings: Acute Ingestion
    1. Gastrointestinal Findings
      1. Abdominal Pain
      2. Nausea and Vomiting
      3. Diarrhea
      4. Gastrointestinal Hemorrhage
    2. Cardiopulmonary Findings
      1. Hypotension (Hypovolemia, Dehydration)
      2. Dysrhythmias (Bradycardia and ventricular Arrhythmias, esp. if Hyperkalemia)
      3. Pulmonary Edema
    3. Neurologic Findings
      1. Altered Mental Status
    4. Miscellaneous Findings
      1. Hyperkalemia
      2. Rhabdomyolysis
  4. Labs
    1. See Unknown Ingestion
    2. Serum Chemistry Panel
      1. Hyperkalemia
      2. Acute Kidney Injury (increased Serum Creatinine)
      3. Rhabdomyolysis (increased Creatine Phosphokinase)
    3. Blood Gas
      1. Venous Blood Gas
      2. Lactic Acid
  5. Imaging
    1. Consider Chest XRay
  6. Diagnostics
    1. Electrocardiogram
  7. Management
    1. See Unknown Ingestion
    2. Decontamination
      1. Skin and eye Decontamination
    3. Supportive Care
      1. Fluid Resuscitation
      2. Hemodialysis
        1. May be indicated in Acute Renal Failure
    4. Disposition
      1. Observe for at least 6 hours after intentional ingestion
      2. Admit for refractory gastrointestinal symptoms or serious findings (gastrointestinal Hemorrhage)
  8. Complications
    1. WHO labels as likely carcinogen (but not U.S. EPA or European EFSA)
    2. Non-Hodgkin's Lymphoma association
      1. Zhang (2019) Mutat Res 781:186-206 +PMID:31342895 [PubMed]
  9. References
    1. Tomaszewski (2019) Crit Dec Emerg Med 33(5):32
    2. Bradberry (2004) Toxicol Rev 23(3):159-67 +PMID:15862083 [PubMed]
    3. Mahendrakar (2014) Indian J Crit Care Med 18(5): 328–330 [PubMed]
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047698/

glyphosate (C0061764)

Concepts Hazardous or Poisonous Substance (T131) , Organophosphorus Compound (T115)
MSH C010974
SnomedCT 311727006
LNC LP34417-3, MTHU017386
English glyphosate, N-(phosphonomethyl)glycine, Glyphosate, Gluphosate (substance), Glyphosate (substance), Gluphosate, gliphosate
Spanish glifosato, glifosato (sustancia), glufosato (sustancia), glufosato
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Gluphosphate causing toxic effect (C0413074)

Concepts Injury or Poisoning (T037)
SnomedCT 241794003
English Gluphosphate caus toxic effect, Gluphosphate causing toxic effect, Gluphosphate causing toxic effect (disorder)
Spanish glucofosfato que causa efectos tóxicos (trastorno), glucofosfato que causa efectos tóxicos
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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