Predicting acute complicated glyphosate intoxication in the emergency department

Glyphosate herbicide intoxication results in a range of mortality and morbidity, depending on patients' factors. Predicting which patient will need intensive medical treatment might help reduce mortality by providing prompt treatment, as well as triage those patients not likely to develop complications. Thus, we sought to identify independent factors that could predict which patient will develop subsequent medical complications.

Seventy-six patients presenting with acute glyphosate herbicide ingestion at Chonnam National University Hospital were enrolled in this retrospective study. To identify the predictive factors for complications, objective variables easily assessed at presentation including previously reported predictive factors for mortality, such as age, vital signs, X-ray abnormalities, and laboratory findings, were analyzed by univariate and multivariate stepwise logistic regression analyses.

Of the 76 patients, 32 (42.1%) had medical complications and 2 (2.6%) died. Metabolic acidosis was the most common medical complication. Whereas metabolic acidosis, respiratory failure, hypotension, acute kidney injury, hyperkalemia, and seizures developed within 24 h, acute pancreatitis occurred a few days after the ingestion. The univariate analysis showed that an advanced age, amount ingested >100 mL, X-ray abnormalities, elevated amylase, alanine aminotransferase (ALT), and blood nitrogen urea were significant factors. However, the multivariate analysis showed that advanced age, elevated ALT, and X-ray abnormalities were independent factors associated with serious complications and the need for intensive medical treatment.

The results of this study showed that age > 50 years, X-ray abnormalities, and ALT > 40 U/L were significant predictive factors for complications in patients with glyphosate surfactant herbicide poisoning; patients with these findings might require admission to the intensive care unit.