Thakur Darshana Sudip, Khot Rajashree, Joshi P P, Pandharipande Madhuri, Nagpure Keshav
Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India.
Toxicol Int. 2014 Sep-Dec;21(3):328-30. doi: 10.4103/0971-6580.155389.
GlySH-surfactant herbicide (GlySH), one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The US Environmental Protection Agency (EPA) states that 'GlySH' is of relatively low oral and acute dermal toxicity. It does not have anticholinesterase effect and no organophosphate-like central nervous system (CNS) effects. The clinical features range from skin and throat irritation to hypotension and death. Severe GlySH-surfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, and shock.[1] GlySH intoxication has a case fatality rate 3.2-29.3%. Pulmonary toxicity and renal toxicity seem to be responsible for mortality. Metabolic acidosis, abnormal chest X-ray, arrhythmias, and elevated serum creatinine levels are useful prognostic factors for predicting GlySH mortality.[2] There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. We report a case of acute pulmonary edema, which is a rare but severe manifestation of oral GlySH poisoning, where patient survived with aggressive supportive therapy.
草甘膦表面活性剂除草剂（GlySH）是全球最常用的除草剂之一，一直被认为对人类毒性极小。然而，临床毒理学家偶尔会遇到严重全身毒性的病例。美国环境保护局（EPA）指出，“GlySH”口服和急性经皮毒性相对较低。它没有抗胆碱酯酶作用，也没有类似有机磷的中枢神经系统（CNS）效应。临床特征从皮肤和喉咙刺激到低血压和死亡不等。严重的草甘膦表面活性剂中毒表现为肠胃炎、呼吸紊乱、精神状态改变、治疗难以纠正的低血压、肾衰竭和休克。[1]草甘膦中毒的病死率为3.2%至29.3%。肺毒性和肾毒性似乎是导致死亡的原因。代谢性酸中毒、胸部X线异常、心律失常和血清肌酐水平升高是预测草甘膦中毒死亡率的有用预后因素。[2]目前尚无解毒剂，全身毒性治疗的主要方法是去污和积极的支持性治疗。我们报告一例急性肺水肿病例，这是口服草甘膦中毒罕见但严重的表现，该患者经积极支持性治疗后存活。
