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Emphysematous pyelonephritis is a severe necrotizing infection that usually occurs in patients with diabetes mellitus or obstructive uropathy. Although glucose fermentation has been considered as the main cause of gas production the actual mechanism remains controversial. Compositions of gas samples from 2 patients with emphysematous pyelonephritis recently encountered were analyzed, and showed 15% hydrogen, 4.8% carbon dioxide, 60% nitrogen, 6.7% oxygen and some unknown gases in case 1, and 3.4% hydrogen, 22% carbon dioxide, 66% nitrogen and 9.8% oxygen in case 2. These results tend to implicate mixed acid fermentation of glucose as the pathway by which emphysematous urinary tract infections develop.

Abstract. Objective: Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate-surfactant herbicide (GlySH) intoxication has been encountered with increasing frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. Methods: This was a retrospective study of 131 GlySH-intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were abstracted, looking for predictors of mortality. Results: The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean Ϯ SEM time to death was 2.8 Ϯ 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x-ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. Conclusions: In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance. Key words: glyphosate; surfactant; herbicide; intoxication; aspiration; pneumonitis. ACADEMIC EMER-GENCY MEDICINE 2000; 7:906-910 H ERBICIDES containing glyphosate, an alternative to paraquat, have recently been used with increasing frequency in suicide attempts throughout Asia. 1-5 Ingestion of a large amount of this chemical may place patients at risk for a toxic syndrome that includes gastrointestinal irritation, hepatic and renal dysfunction, cardiovascular instability, and pulmonary insufficiency. 2-6 Although glyphosate-surfactant herbicide (GlySH) is considered to be only slightly toxic in rats, ingestion of a substantial volume of GlySH has been reported to be associated with toxicity and death in humans. 4,5 A number of reports have described the clinical course and outcomes following ingestion;From the Departments of Emergency Medicine (HLL, KWC, CHC, LMT) and Internal Medicine (JJH), National Cheng Kung University Hospital, Tainan, Taiwan. Received July 7, 1999; revisions received October 29, 1999, and January 24, 2000; accepted February 21, 2000. Address for correspondence and reprints: Kuan-Wen Chen...

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