title: Use of a lipid emulsion in a patient with refractory hypotension caused by glyphosate-surfactant herbicide.
abstract: BACKGROUND
  Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE).
  
  
  METHODS
  A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered.
  
  
  CONCLUSIONS
  IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.
authors.affiliation: Department of Emergency Medicine, Pusan National University Hospital, Seo-Gu, Busan, Republic of Korea.
authors.forename: Sang Kyoon
authors.initials: SK
authors.lastname: Han
authors.forename: Jinwoo
authors.initials: J
authors.lastname: Jeong
authors.forename: Seokran
authors.initials: S
authors.lastname: Yeom
authors.forename: Jiho
authors.initials: J
authors.lastname: Ryu
authors.forename: Sungwook
authors.initials: S
authors.lastname: Park
mesh_terms: D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005998:Glycine / Q000031:analogs & derivatives* / Q000506:poisoning; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D000097797:Glyphosate
chemical_list: D005217:Fat Emulsions, Intravenous; D005998:Glycine; D006540:Herbicides; D000097797:Glyphosate