Treatment of severe 2,4-D and mecoprop intoxication with alkaline diuresis

1 Self-poisoning with a selective weedkiller containing 2,4-D and mecoprop in a 39 year old man resulted in prolonged deep coma, pyrexia, hyperventilation, hypoxaemia, myotonia, skeletal muscle damage and electrocardiographic changes consistent with cardiomyopathy. 2 The admission plasma concentrations of 2,4-D and mecoprop were 400 and 751 microgram/ml respectively. The patient remained gravely ill with no signs of improvement for 2 days with supportive therapy and there was no fall in the 2,4-D level. 3 Alkaline diuresis greatly increased the renal clearance of 2,4-D, and there was a rapid fall in plasma concentration (T1/2 3.7 h) with corresponding clinical improvement. The effect on the elimination of mecoprop was similar, but less dramatic. 4 Forced alkaline diuresis may improve the otherwise very poor prognosis in severe intoxication with 2,4-D and related weedkillers.