Successful extracorporeal membrane oxygenation support for severe acute diquat and glyphosate poisoning

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Abstract

Rationale:

Because of the lack of an antidote or effective treatment, patients with severe acute diquat and glyphosate poisoning always died within a few hours. Extracorporeal membrane pulmonary oxygenation (ECMO), as an artificial heart-lung supporting system, can be applied to support lung that is expected to recover from reversible pathological damage. However, to our knowledge, the application of ECMO for patients with diquat and glyphosate poisoning has not been reported.

Patient concerns:

A 40-year-old man ingested in 100 ml of diquat (20 g/100 ml) and 400 ml glyphosate (41 g/100 ml) was admitted to the intensive care unit (ICU), immediately complicated by the development of ventricular fibrillation, respiratory failure, renal failure, and multi-organ failure.

Diagnosis:

Diquat and glyphosate poisoning were diagnosed by stated ingestion history, and the diagnostic criteria for acute respiratory distress syndrome (ARDS) and multi-organ dysfunction syndrome were also met.

Interventions:

He was treated with veno-venous ECMO.

Outcomes:

He was successfully transferred out of the ICU on day 46 and discharged on day 67. The computed tomography scan showed no obvious pulmonary fibrosis 2 months after poisoning.

Lessons:

ECMO may be effective in the treatment of patients with severe ARDS caused by diquat and glyphosate poisoning when conventional management does not work.

Related collections

Most cited references 21

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Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts.

Eddy Fan, Luciano Gattinoni, Alain Combes … (2016)

Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO.

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Human and experimental toxicology of diquat poisoning: Toxicokinetics, mechanisms of toxicity, clinical features, and treatment.

N Magalhaes, F. Carvalho, R J Dinis-Oliveira (2018)

Diquat (1,1'-ethylene-2,2'-bipyridinium ion; DQ) is a nonselective quick-acting herbicide, which is used as contact and preharvest desiccant to control terrestrial and aquatic vegetation. Several cases of human poisoning were reported worldwide mainly due to intentional ingestion of the liquid formulations. Its toxic potential results from its ability to produce reactive oxygen and nitrogen species through redox cycling processes that can lead to oxidative stress and potentially cell death. Kidney is the main target organ due to DQ toxicokinetics and redox cycling. There is no antidote against DQ intoxications, and the efficacy of treatments currently applied is still unsatisfactory. The aim of this work was to review the most relevant human and experimental findings related to DQ, characterizing its chemistry, activity as herbicide, mechanisms of toxicity, consequences of poisoning, and potential therapeutic approaches taking into account previous experience in developing antidotes for paraquat, a more toxic bipyridinium herbicide.

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Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review.

G M Jones, J A Vale (2000)

USES: Diquat (1,1'-ethylene-2,2'-bipyridilium) is a nonselective bipyridyl herbicide, related structurally to paraquat, which is used both as a contact herbicide and a preharvest desiccant. In comparison to paraquat, diquat is used much less widely in agriculture. Diquat is a potent redox cycler and is readily converted to a free radical which, in reaction with molecular oxygen, generates superoxide anions and subsequently other redox products. These products can induce lipid peroxidation in cell membranes, and potentially cause cell death. Over the period 1968-1999, only 30 cases of diquat poisoning were reported in detail in the literature, of which 13 (43%) were fatal. Local and systemic effects have been reported following diquat exposure, with systemic features being invariably associated with ingestion. In severe and usually fatal cases, gastrointestinal mucosal ulceration, paralytic ileus, hypovolemic shock, acute renal failure, and coma have been reported. After rapid confirmation of the diagnosis using a qualitative urine test, gut decontamination may be considered in patients who present within 1 hour of a life-threatening ingestion (>6 g). Supportive measures including fluid and electrolyte replacement should then be employed. Although hemofiltration and hemodialysis are of proven value if renal failure supervenes, there is no clinical evidence that hemodialysis or hemoperfusion removes toxicologically significant amounts of diquat, thereby reducing the risk of organ failure and preventing a fatal outcome in severe cases.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: February 2019

Publication date (Electronic): 08 February 2019

Volume: 98

Issue: 6

Electronic Location Identifier: e14414

Affiliations

[a ]Department of Critical Care Medicine, Quzhou People's Hospital, Quzhou

[b ]Zhejiang Chinese Medical University, Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China.

Author notes

[∗ ]Correspondence: Danqiong Wang, Department of Critical Care Medicine, Quzhou People's Hospital, 2 Zhongloudi Road, Quzhou 324000, Zhejiang, People's Republic of China. (e-mail: danqiong.w@ 123456hotmail.com ).

Article

Publisher ID: MD-D-18-08393 Accession ID: 14414

DOI: 10.1097/MD.0000000000014414

PMC ID: 6380784

PubMed ID: 30732194

SO-VID: 9ff84c11-d57e-4507-9439-e1cac320aa5a

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 15 November 2018

Date revision received : 8 January 2019

Date accepted : 15 January 2019

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Keywords: case report,diquat,extracorporeal membrane oxygenation therapy,glyphosate,poisoning

Data availability:

Keywords: case report, diquat, extracorporeal membrane oxygenation therapy, glyphosate, poisoning

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Successful extracorporeal membrane oxygenation support for severe acute diquat and glyphosate poisoning : A case report

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Abstract

Rationale:

Patient concerns:

Diagnosis:

Interventions:

Outcomes:

Lessons:

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 21

Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts.

Human and experimental toxicology of diquat poisoning: Toxicokinetics, mechanisms of toxicity, clinical features, and treatment.

Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review.

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