Glufosinate ammonium poisoning: A rare clinical presentation

A 32-year-old male presented with a history of decreased urine output following an alleged history of deliberate self-harm by consuming glufosinate ammonium 13.5% w/w SL herbicide (Synkill®) two days earlier. General physical examination revealed pulse 86 beats/minute, blood pressure 140/90 mmHg, and respiratory rate 20/minute. Laboratory investigations revealed elevated serum creatinine (5.96 mg/dl), creatinine phosphokinase (340 i.u./L), and elevated serum hepatic transaminases. On day 6 of hospitalization, he developed right-sided lower motor neuron facial palsy and was started on oral prednisolone. The following day, the weakness progressed, and bilateral lower motor neuron facial palsy developed. During the next few days, a descending type of flaccid paralysis developed, including involvement of respiratory muscles, requiring assisted mechanical ventilatory support. Magnetic resonance imaging (MRI) of the brain showed a normal study. The electroneuromyography test showed prolonged latency with reduced amplitude and conduction velocity. The sensorium of the patient also worsened with a Glasgow Coma Scale (GCS) of E1VTM1 by day 11 of hospital stay. A computed tomography scan of the brain done after a fall in GCS showed no abnormality of the brain parenchyma. The blood and urine samples sent for toxicological analysis revealed the presence of glufosinate in urine alone. The patient was discharged against medical advice from the hospital. Our patients highlights a very rare manifestation of glufosinate ammonium herbicide poisoning.