title: Acute intentional self-poisoning with a herbicide product containing fenoxaprop-P-ethyl, ethoxysulfuron, and isoxadifen ethyl: a prospective observational study.
abstract: 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.
authors: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. shukry79@hotmail.com
authors: Shukry
authors: S
authors: Zawahir
authors: Darren M
authors: DM
authors: Roberts
authors: Chathura
authors: C
authors: Palangasinghe
authors: Fahim
authors: F
authors: Mohamed
authors: Michael
authors: M
authors: Eddleston
authors: Andrew H
authors: AH
authors: Dawson
authors: Nick A
authors: NA
authors: Buckley
authors: Lingling
authors: L
authors: Ren
authors: Gregory A
authors: GA
authors: Medley
authors: Indika
authors: I
authors: Gawarammana
mesh_terms: 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
chemical_list: 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