• Sang Kyoon Han, Jinwoo Jeong, Seokran Yeom, Jiho Ryu, and Sungwook Park.
• Department of Emergency Medicine, Pusan National University Hospital, Seo-Gu, Busan, Republic of Korea.
• Clin Toxicol (Phila). 2010 Jul 1; 48 (6): 566-8.

ContextCirculatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE).Case DetailsA 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered.ConclusionIFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.

14 keywords...

hide…