Acute intentional self-poisoning with a herbicide product containing fenoxaprop-P-ethyl, ethoxysulfuron, and isoxadifen ethyl: a prospective observational study.
BACKGROUND
Herbicides are commonly ingested for self-harm, but relatively little has been published on poisoning with herbicides other than paraquat and glyphosate. We report here a case series of patients with acute exposure to a combination herbicide (brand name Tiller Gold or Whip Super) containing the selective phenoxy herbicide compounds fenoxaprop-P-ethyl and ethoxysulfuron and a safener isoxadifen ethyl.


METHODS
Clinical data on all patients presenting with Tiller Gold or Whip Super poisoning to two General Hospitals in Sri Lanka from 2002-2008 were collected prospectively until discharge.


RESULTS
Eighty-six patients with a history of Tiller Gold or Whip Super ingestion were included. The main clinical features were an epigastric burning sensation and vomiting; however, most of those who vomited had received gastric lavage or forced emesis. Eight patients had a reduced level of consciousness on admission (Glasgow coma scale 9-14) that resolved without intervention over several hours. Only symptomatic and supportive care was required. The median hospital stay was 1 day (IQR: 1-2) and the case fatality was zero (95% confidence interval: 0-4.2%). This low case fatality compared favorably with the case fatality of other common herbicides in our cohort: paraquat >40%, propanil >10%, 4-chloro-2-methylphenoxyacetic acid > 5%, and glyphosate >2%.


CONCLUSIONS
This combination herbicide product appears to be safe in patients with acute self-poisoning, particularly in comparison with other herbicides, and causing few clinical features.
Zawahir
Shukry
S
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. shukry79@hotmail.com
Roberts
Darren M
DM
Palangasinghe
Chathura
C
Mohamed
Fahim
F
Eddleston
Michael
M
Dawson
Andrew H
AH
Buckley
Nick A
NA
Ren
Lingling
L
Medley
Gregory A
GA
Gawarammana
Indika
I
D000208:Acute Disease; D003257:Consumer Product Safety; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D006540:Herbicides / Q000493:pharmacokinetics / Q000506:poisoning*; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D010080:Oxazoles / Q000493:pharmacokinetics / Q000506:poisoning* / Q000633:toxicity*; D011422:Propionates / Q000493:pharmacokinetics / Q000506:poisoning*; D011446:Prospective Studies; D018570:Risk Assessment; D013188:Sri Lanka; D013405:Suicide; D013453:Sulfonylurea Compounds / Q000493:pharmacokinetics / Q000506:poisoning* / Q000633:toxicity; D016896:Treatment Outcome
D006540:Herbicides; D010080:Oxazoles; D011422:Propionates; D013453:Sulfonylurea Compounds; C544125:1-(4,6-dimethoxypyrimidin-2-yl)-3-(2-ethoxyphenoxysulfonyl)urea; C544124:ethyl-4,5-dihydro-5,5-diphenylisoxazol-3-carboxylate; C416661:fenoxaprop ethyl