Chen Ying-Ju, Wu Ming-Ling, Deng Jou-Fang, Yang Chen-Chang
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Clin Toxicol (Phila). 2009 Aug;47(7):670-7. doi: 10.1080/15563650903140399.
Glyphosate-surfactant herbicide (GlySH) is widely used in agriculture and has been associated with numerous toxicities following oral ingestion. However, there are many controversies with regard to the exact causes and determinants of developing severe/death outcome after exposure to GlySH.
We conducted an analysis of all GlySH exposures reported to the Taiwan National Poison Control Center between 1986 and 2007. Patients' baseline characteristics and clinical data were reviewed and analyzed.
A total of 2,186 patients were eligible for analysis. Most of the exposures were related to oral ingestion (n = 2,023, 92.5%) and attempted suicide (n = 1,631, 74.6%). The mean age of exposure was 42.8 +/- 18.6 years. One hundred patients developed severe effects and 146 patients died following oral GlySH exposure, resulting in a case fatality rate of 7.2%. Shock (n = 85, 58.2%) and respiratory failure (n = 34, 23.3%) accounted for most fatalities. Four out of eight patients with injection exposure manifested severe (n = 3) or fatal outcome (n = 1). In a multivariate logistic regression analysis, increasing age, larger amount of exposure, longer elapsed time to presentation, attempted suicide, receipt of atropine therapy, and being exposed in certain calendar years were positively associated with the severity of poisoning following oral GlySH exposure.
Age, ingested amount, delayed presentation, and reason for exposure were likely to be determinants of the severity of GlySH exposure. Because shock is the major cause of death and usually develops early after GlySH exposure, prompt fluid replacement therapy seems critical in the initial management of such exposures. Patients' airway should also be secured to avoid aspiration and subsequent respiratory failure.
草甘膦 - 表面活性剂除草剂（GlySH）在农业中广泛使用，口服摄入后会引发多种毒性反应。然而，关于接触GlySH后出现严重后果/死亡的确切原因和决定因素存在诸多争议。
我们对1986年至2007年期间向台湾地区毒物控制中心报告的所有GlySH暴露病例进行了分析。回顾并分析了患者的基线特征和临床数据。
共有2186例患者符合分析条件。大多数暴露与口服摄入有关（n = 2023，92.5%）且多为自杀未遂（n = 1631，74.6%）。暴露的平均年龄为42.8±18.6岁。口服GlySH暴露后，100例患者出现严重后果，146例患者死亡，病死率为7.2%。休克（n = 85，58.2%）和呼吸衰竭（n = 34，23.3%）是主要死因。8例注射暴露患者中有4例出现严重后果（n = 3）或死亡（n = 1）。在多因素逻辑回归分析中，年龄增长、暴露量增加、就诊时间延长、自杀未遂、接受阿托品治疗以及在特定年份暴露与口服GlySH暴露后中毒的严重程度呈正相关。
年龄、摄入量、就诊延迟和暴露原因可能是GlySH暴露严重程度的决定因素。由于休克是主要死因且通常在GlySH暴露后早期发生，因此在这类暴露的初始处理中，及时进行液体替代治疗似乎至关重要。还应确保患者气道安全，以避免误吸及随后的呼吸衰竭。
