2,4-Dichlorophenoxyacetic Acid Poisoning Mimicking as Organophosphorus Poisoning

Different compounds such as organochlorines, pyrethroids, fungicides, 2,4-dichlorophenoxy (2,4-D) herbicides, mushrooms, opioids, cartap compounds, and amitraz compounds can mimic organophosphorus (OP) poisoning. Muscle fasciculation, pulmonary edema, convulsions, bradycardia, hypotension, and smell caused by pyrethroids, as well as neurological signs, seizures, pulmonary edema, and smell caused by organochlorines can mimic OP poisoning. Miosis, vomiting, coma, and hypotension caused by opioids; miosis, bradycardia, altered sensorium, respiratory depression, and hypotension caused by amitraz compounds; and vomiting, breathlessness, altered sensorium, hypotension, and seizures caused by cartap compounds can also mimic OP poisoning. Mushroom poisoning and few fungicide compounds are also known to mimic features of OP poisoning. Hyperglycemia and glycosuria are the key hallmarks of amitraz poisoning. 2,4-D compounds can also mimic most of the features of OP poisoning; however, rhabdomyolysis, coma, and hyper/hypotonia are key differentiating features. Allergic manifestation and greenish discoloration of the contacted skin are the differentiating features of cartap poisoning. Treating all agriculture-related poisoning with atropine without confirming the compound can lead to a therapeutic misadventure. Here, we discuss the case of a patient who was referred to our Emergency Department (ED) with an alleged history of an unknown poison ingestion which was managed with atropinization for suspected OP poisoning in an outside hospital. On probing the history, the actual compound was found to be a 2,4-D herbicide. Very few documented case reports of 2,4-D poisoning are available in the literature. Hyper/hypotonia, coma, and skeletal muscle damage are the key differentiating features of 2,4-D poisoning. Our patient had skeletal muscle damage (rhabdomyolysis), evidenced by raised creatine kinase-total and creatine kinase-muscle/brain. As there is no specific antidote, we treated the patient with urinary alkalinization and supportive care. The patient had a favorable outcome in the ED.