سامانه مدیریت نشریات علمی دانشگاه علوم پزشکی مشهد

Ishii, Takashi, Matsuo, Kazuhiro, Ichibayashi, Ryo. (1404). A Case of Mixed Herbicide Poisoning Presenting with Diverse Findings: Diagnostic Pitfalls and the Importance of Psychosocial Context. , 15(1), 49-52. doi: 10.22038/apjmt.2026.92632.1547
Takashi Ishii; Kazuhiro Matsuo; Ryo Ichibayashi. "A Case of Mixed Herbicide Poisoning Presenting with Diverse Findings: Diagnostic Pitfalls and the Importance of Psychosocial Context". , 15, 1, 1404, 49-52. doi: 10.22038/apjmt.2026.92632.1547
Ishii, Takashi, Matsuo, Kazuhiro, Ichibayashi, Ryo. (1404). 'A Case of Mixed Herbicide Poisoning Presenting with Diverse Findings: Diagnostic Pitfalls and the Importance of Psychosocial Context', , 15(1), pp. 49-52. doi: 10.22038/apjmt.2026.92632.1547
Ishii, Takashi, Matsuo, Kazuhiro, Ichibayashi, Ryo. A Case of Mixed Herbicide Poisoning Presenting with Diverse Findings: Diagnostic Pitfalls and the Importance of Psychosocial Context. , 1404; 15(1): 49-52. doi: 10.22038/apjmt.2026.92632.1547

A Case of Mixed Herbicide Poisoning Presenting with Diverse Findings: Diagnostic Pitfalls and the Importance of Psychosocial Context

Asia Pacific Journal of Medical Toxicology
مقاله 8، دوره 15، شماره 1، خرداد 2026، صفحه 49-52    اصل مقاله (312.97 K)
نوع مقاله: Case Report
شناسه دیجیتال (DOI): 10.22038/apjmt.2026.92632.1547
نویسندگان
Takashi Ishii1؛ Kazuhiro Matsuo2؛ Ryo Ichibayashi* 1
1Division of Emergency Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
2Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
چکیده
Background: Although glyphosate-based herbicides are generally considered to have low acute toxicity to humans, commercially available formulations may contain multiple active ingredients and co-formulants that produce atypical clinical manifestations.
Case Presentation: A 53-year-old woman with a history of panic disorder and kleptomania was found collapsed at home by her family just before incarceration. On arrival, she had marked bilateral mydriasis (8 mm), impaired consciousness (Glasgow Coma Scale: E1V1M1), QTc prolongation (633 ms), metabolic acidosis, and elevated lactate. Stimulant intoxication was initially considered because of mydriasis and a positive urine amphetamine screen; however, she lacked hypertension, tachycardia, diaphoresis, and agitation, and QT prolongation was not interpreted as evidence of adrenergic stimulation. Detailed history-taking and UPLC-HRMS toxicological analysis revealed ingestion of a commercial herbicide containing glyphosate isopropylamine salt, flumioxazin, and MCPA, with MCPA detected in serum. She improved with conservative treatment and was discharged on hospital day 8.
Discussion: This case illustrates atypical toxicosis caused by a multi-ingredient herbicide. The presentation did not fulfill a classic sympathomimetic toxidrome; instead, mydriasis, impaired consciousness, QT prolongation, and ileus required broad differential diagnosis. Component-specific assessment suggested that glyphosate-surfactant exposure, MCPA toxicity, and uncertain co-formulant effects together contributed to the clinical picture. Quantitative pupillometry and confirmatory toxicological analysis helped avoid diagnostic anchoring.
Conclusion: Commercial herbicide poisoning should not automatically be interpreted as single-agent glyphosate poisoning. Separating key clinical problems from formulation-specific toxicities may improve emergency diagnosis and management.
کلیدواژه‌ها
Glyphosate poisoning؛ Toxidromes؛ Mydriasis؛ Herbicide؛ Diagnostic errors
مراجع
  1. Williams GM, Kroes R, Munro IC. Safety evaluation and risk assessment of the herbicide Roundup and its active ingredient, glyphosate, for humans. Regul Toxicol Pharmacol. 2000;31(2 Pt 1):117-65.
  2. Bradberry SM, Proudfoot AT, Vale JA. Glyphosate poisoning. Toxicol Rev. 2004;23(3):159-67.
  3. Mesnage R, Bernay B, Séralini GE. Ethoxylated adjuvants of glyphosate-based herbicides are active principles of human cell toxicity. Toxicology. 2013;313(2-3):122-8.
  4. Lee HL, Chen KW, Chi CH, Huang JJ, Tsai LM. Clinical presentations and prognostic factors of a glyphosate-surfactant herbicide intoxication: a review of 131 cases. Acad Emerg Med. 2000;7(8):906-10.
  5. Pope JD, Drummer OH, Schneider HG. False-Positive Amphetamines in Urine Drug Screens: A 6-Year Review. J Anal Toxicol. 2023;47(3):263-70.
  6. Petrov M, Sakelarova T, Velinov N, Dimitrova M, Gabrovsky N. The Presence of Bilateral Dilated Pupils is Not a Death Sentence in a Stroke Patient: A Case Report. Cureus. 2024;16(9):e69133.
  7. Sanello A, Gausche-Hill M, Mulkerin W, Sporer KA, Brown JF, Koenig KL, et al. Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care. West J Emerg Med. 2018;19(3):527-41.
  8. Caglayan HZ, Colpak IA, Kansu T. A diagnostic challenge: dilated pupil. Curr Opin Ophthalmol. 2013;24(6):550-7.
  9. Hoffman RJ, Nillas A. Toxidromes and a general approach to poisoning. Arch Dis Child. 2025;110(9):681-6.
  10. Malek N, Baker MR. Common toxidromes in movement disorder neurology. Postgrad Med J. 2017;93(1100):326-32.
  11. Roberts DM, Seneviratne R, Mohammed F, Patel R, Senarathna L, Hittarage A, et al. Intentional self-poisoning with the chlorophenoxy herbicide 4-chloro-2-methylphenoxyacetic acid (MCPA). Ann Emerg Med. 2005;46(3):275-84.
  12. Ichibayashi R, Suzuki G, Nakamichi Y, Masuyama Y, Yamamoto S, Serizawa H, et al. Management of organic phosphorus poisoning using a pupillometer: a case report. QJM. 2022;115(6):415-6.
  13. Morelli P, Oddo M, Ben-Hamouda N. Role of automated pupillometry in critically ill patients. Minerva Anestesiol. 2019;85(9):995-1002.
  14. Jolkovsky EL, Fernandez-Penny FE, Alexis M, Benson LN, Wang BH, Abella BS. Impact of acute intoxication on quantitative pupillometry assessment in the emergency department. J Am Coll Emerg Physicians Open. 2022;3(5):e12825.
  15. Hall CA, Chilcott RP. Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics. Diagnostics (Basel). 2018;8(1).
آمار
تعداد مشاهده مقاله: 94
تعداد دریافت فایل اصل مقاله: 111