title: Alkaline diuresis for acute poisoning with chlorophenoxy herbicides and ioxynil.
abstract: The relation between blood chlorophenoxy herbicide and ioxynil concentrations and toxicity, and the effect of alkaline diuresis on outcome, have been studied in 41 patients. More than one herbicide was found in 38 cases. 6 of 30 patients who had ingested chlorophenoxy compounds alone died; 16 patients (mostly in grade 3-4 coma) had alkaline diuresis and 15 survived. 7 of 11 patients who had co-ingested ioxynil died; 3 had alkaline diuresis and all survived. Alkaline diuresis reduced plasma chlorophenoxy half-lives to values observed after doses that had no adverse effects (ie, below 30 h), but did not influence ioxynil clearance. Alkaline diuresis should be used to treat acute poisoning with chlorophenoxy herbicides or ioxynil in the presence of coma or other poor prognostic indicators, such as acidaemia, or if plasma total chlorophenoxy concentrations are 0.5 g/l or more.
authors.affiliation: Poisons Unit, Guy's Hospital, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Flanagan
authors.forename: T J
authors.initials: TJ
authors.lastname: Meredith
authors.forename: M
authors.initials: M
authors.lastname: Ruprah
authors.forename: L J
authors.initials: LJ
authors.lastname: Onyon
authors.forename: A
authors.initials: A
authors.lastname: Liddle
mesh_terms: D015085:2,4,5-Trichlorophenoxyacetic Acid / Q000097:blood / Q000506:poisoning / Q000652:urine; D015084:2,4-Dichlorophenoxyacetic Acid / Q000097:blood / Q000506:poisoning / Q000652:urine; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D002648:Child; D003128:Coma / Q000097:blood / Q000139:chemically induced / Q000401:mortality / Q000628:therapy / Q000652:urine; D003996:Dicamba / Q000097:blood / Q000506:poisoning / Q000652:urine; D004231:Diuresis / Q000187:drug effects*; D005069:Evaluation Studies as Topic; D005260:Female; D006207:Half-Life; D006540:Herbicides / Q000097:blood / Q000506:poisoning* / Q000652:urine; D006801:Humans; D007262:Infusions, Intravenous; D007462:Iodobenzenes / Q000097:blood / Q000506:poisoning / Q000652:urine; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000097:blood / Q000506:poisoning* / Q000652:urine; D011379:Prognosis; D011446:Prospective Studies; D012964:Sodium / Q000008:administration & dosage / Q000627:therapeutic use*; D017693:Sodium Bicarbonate; D013406:Suicide, Attempted; D013997:Time Factors
chemical_list: D001639:Bicarbonates; D006540:Herbicides; D007462:Iodobenzenes; D009570:Nitriles; D015084:2,4-Dichlorophenoxyacetic Acid; D017693:Sodium Bicarbonate; C008161:ioxynil; D012964:Sodium; D015085:2,4,5-Trichlorophenoxyacetic Acid; D003996:Dicamba