Metabolic acidosis in prometryn (triazine herbicide) self-poisoning.
BACKGROUND
Prometryn is a triazine herbicide, which is one of the most extensively used groups of herbicides. The mechanism of acute triazine herbicide toxicity in humans is not known. We report a first case of acute prometryn poisoning.


METHODS
A 62-year-old male ingested 50 g of prometryn and ethanol in a suicide attempt. On arrival two hours after ingestion, he was somnolent and vomited. Seven hours after ingestion laboratory tests showed metabolic acidosis with a calculated anion gap of 47.5 mmol/L and lactate of 23.4 mmol/L. Gas chromatography/mass spectrometry revealed serum prometryn concentrations of 48.1 mg/L. Hemodialysis corrected metabolic acidosis, but the serum prometryn concentration increased to 67.7 mg/L. The lactate level after hemodialysis was 11.7 mmol/L and returned within normal limits 47 hours after ingestion. The patient was discharged without any sequelae after psychiatric evaluation.


CONCLUSIONS
In high anion gap metabolic acidosis we should consider poisoning with prometryn and other triazine herbicides. Hemodialysis corrects metabolic derangements, but it does not lower serum prometryn concentration.
Brvar
Miran
M
Poison Control Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia. miran.brvar@kclj.si
Okrajsek
Renata
R
Kosmina
Polona
P
Staric
Feliks
F
Kaps
Rafael
R
Kozelj
Gordana
G
Bunc
Matjaz
M
D000138:Acidosis / Q000139:chemically induced*; D001639:Bicarbonates / Q000097:blood; D008401:Gas Chromatography-Mass Spectrometry; D006540:Herbicides / Q000097:blood / Q000506:poisoning*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011400:Prometryne / Q000097:blood / Q000506:poisoning*; D006435:Renal Dialysis; D013406:Suicide, Attempted
D001639:Bicarbonates; D006540:Herbicides; D011400:Prometryne; D019344:Lactic Acid