A Case of Transient Diabetes Insipidus Associated with Poisoning by a Herbicide Containing Glufosinate

Takahashi, Hiroshi; Toya, Tsuyoshi; Matsumiya, Naoki; Koyama, Kanji

doi:10.1081/clt-100100931

Cited by 8 publications

(4 citation statements)

References 13 publications

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“…19 Recovery from glufosinate poisoning is prolonged and extubation may be delayed for a week or more. Central diabetes insipidus has been well documented in one reported case 20 but was not present in our patient.…”

Section: Discussioncontrasting

confidence: 48%

Severe acute poisoning due to a glufosinate containing preparation without mitochondrial involvement

2008

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Glufosinate is a non-selective herbicide widely used in domestic gardens and agriculture. Few cases of glufosinate poisoning have been reported although there has been an increase in recent years, particularly in Japan. Glufosinate toxicity is related to its capacity to inhibit glutamine synthetase and glutamate decarboxylase, which may lead to a potentially fatal multiorgan failure. We report the case of a 41-year-old woman who ingested between 30 and 50 mL of a herbicide (Finale®) containing glufosinate (14%) in a suicide attempt. One hour after ingestion, the patient attended the Emergency Department of her own volition. Her overall status was good, and the physical examination was unremarkable. Gastric lavage was carried out, 25 g of activated charcoal was administered, and the patient was admitted for observation. Seventeen hours later, the patient presented drowsiness and a sinus bradycardia of 40 bpm. Thirty-two hours after ingestion, the Glasgow Coma Score was 8, and orotracheal intubation and mechanical ventilation were begun. At 3 days, the patient presented a self-limiting episode of ventricular tachycardia. She recovered consciousness progressively and was extubated without complications. The evolution was favorable, but the sinus bradycardia persisted up to 8 days after the ingestion. A study of lymphocyte mitochondrial function showed no alteration in mitochondrial oxidative capacity or the enzymatic activity of the complexes of the electron transport chain. A small ingestion of glufosinate can cause severe poisoning, whose manifestations predominantly involve the central nervous system and heart rhythm. Signs and symptoms may not appear for several hours and may persist for several days. In spite of these multi-organ manifestations, no alteration in lymphocyte mitochondrial function has been reported.

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Section: Discussioncontrasting

confidence: 48%

Severe acute poisoning due to a glufosinate containing preparation without mitochondrial involvement

2008

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“…Several case studies of diabetes induced by pesticide poisoning have been reported (Takahashi et al 2000), and one study of 23 subjects admitted to an Indian intensive care unit with carbamate or organophosphate poisoning found 69% of subjects demonstrated transient glycosuria (Shobha and Prakash 2000).…”

Section: Discussionmentioning

confidence: 99%

Health impacts of pesticide exposure in a cohort of outdoor workers.

Beard

Sladden

Morgan

et al. 2003

Environ Health Perspect

113

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We compared mortality of 1,999 outdoor staff working as part of an insecticide application program during 1935-1996 with that of 1,984 outdoor workers not occupationally exposed to insecticides, and with the Australian population. Surviving subjects also completed a morbidity questionnaire. Mortality was significantly higher in both exposed and control subjects compared with the Australian population. The major cause was mortality from smoking-related diseases. Mortality was also significantly increased in exposed subjects for a number of conditions that do not appear to be the result of smoking patterns. Compared with the general Australian population, mortality over the total study period was increased for asthma [standardized mortality ratio (SMR) = 3.45; 95% confidence interval (CI), 1.39-7.10] and for diabetes (SMR = 3.57; 95% CI, 1.16-8.32 for subjects working < 5 years). Mortality from pancreatic cancer was more frequent in subjects exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (SMR = 5.27; 95% CI, 1.09-15.40 for subjects working < 3 years). Compared with the control population, mortality from leukemia was increased in subjects working with more modern chemicals (standardized incidence ratio = 20.90; 95% CI, 1.54-284.41 for myeloid leukemia in the highest exposure group). There was also an increase in self-reported chronic illness and asthma, and lower neuropsychologic functioning scores among surviving exposed subjects when compared with controls. Diabetes was reported more commonly by subjects reporting occupational use of herbicides. These findings lend weight to other studies suggesting an association between adverse health effects and exposure to pesticides.

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“…Our patient had central DI as the patient responded after desmopressin. There have been a few case reports of central DI following malathion [5], glufosinate [6], carbon monoxide [7] poisoning and overdose of baclofen and quetiapine [8] but there has been no case report following diethyl compound of OP. Central DI is common following pituitary surgery, tumour, infections, granulomas, inflammatory condition, vascular, chemical toxin and genetic but 50% is idiopathic [9], and our patient did not any of these causes.…”

Section: Discussionmentioning

confidence: 99%

Transient Diabetes Insipidus Following Organophosphorus Poisoning

Keyal

Bhujel

2019

The Journal of Critical Care Medicine

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Introduction Organophosphorus poisoning is the most common poison used for suicidal attempt in Nepal. Diabetes insipidus is unusual and rare in this poisoning. This is the second case report of Diabetes insipidus developing in organophosphorus poisoning. Management of diabetes insipidus includes desmopressin and adequate fluid management. Case presentation A 34-year-old female patient accompanied by her father presented at the Emergency department with an alleged history of ingestion of unknown amount of chlorpyrifos, cypermethrin and quinalphos. On admission, she had a Glasgow Coma Scale (GCS) of 7/15. Her blood pressure was 110/60 mm Hg, pulse 54/min, respiratory rate 45/min and saturation 35% on room air, pinpoint pupil reactive to light and bilateral crepitations. She was immediately resuscitated with two litres of normal saline and intubated with a 7 mm endotracheal tube. Atropinisation was done, and pralidoxime was started. She developed a urine output of 250-350 ml per hour with rising sodium and serum osmolality. The urine examination showed low sodium and urine specific gravity. A diagnosis of diabetes insipidus was made. There was no immediate improvement in her GCS. She was managed with 5% dextrose and subcutaneous desmopressin and was transferred out of the intensive care unit on the sixth day and was discharged from hospital on the fifteenth day. Conclusion Diabetes insipidus is a rare transient complication in organophosphorus poisoning that requires careful observation and early management with desmopressin and adequate fluid balance to improve patient outcome.

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A Case of Transient Diabetes Insipidus Associated with Poisoning by a Herbicide Containing Glufosinate

Cited by 8 publications

References 13 publications

Severe acute poisoning due to a glufosinate containing preparation without mitochondrial involvement

Severe acute poisoning due to a glufosinate containing preparation without mitochondrial involvement

Health impacts of pesticide exposure in a cohort of outdoor workers.

Transient Diabetes Insipidus Following Organophosphorus Poisoning

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