title: Surfactant volume is an essential element in human toxicity in acute glyphosate herbicide intoxication.
abstract: BACKGROUND
  Glyphosate, one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The purpose of this study was to determine the effect of glyphosate-surfactants ("glyphosate-surfactant toxicity") in patients with acute glyphosate intoxication.
  
  
  METHODS
  In all, 107 patients (69 men and 38 women, aged 52.3 ± 15.5 years) with acute glyphosate intoxication were enrolled in this study. From their medical records, we identified the formulation of ingested glyphosate products and derived clinical parameters, which focused on clinical outcome, admission days, duration in the intensive care unit, development of respiratory failure, cardiovascular deterioration, renal failure, altered mental status, and convulsions. The effect of surfactants on clinical complications was also assessed.
  
  
  RESULTS
  For surfactant ingestion volumes of 8 mL, the incidence of clinical complications was (in rank order) as follows: hypotension, 47.1%; mental deterioration, 38.6%; respiratory failure, 30.0%; acute kidney injury, 17.1%; and arrhythmia, 10.0%. These complications were influenced by the volume of surfactant and not the type of surfactant-ingredient in the herbicide product. Two patients died of refractory shock, metabolic acidosis, and respiratory failure. However, the final clinical outcomes of the surviving patients were benign, and cardiovascular, respiratory, kidney, and mental functions were fully restored to normal levels.
  
  
  CONCLUSIONS
  Our results indicate that treatment of patients with acute glyphosate herbicide intoxication should take into account the volume and not the type of surfactants in herbicide formulations.
authors.affiliation: Nephrotoxicology, Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Su-Jin
authors.initials: SJ
authors.lastname: Seok
authors.forename: Jae-Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Joong-Rock
authors.initials: JR
authors.lastname: Hong
authors.forename: Hyo-Wook
authors.initials: HW
authors.lastname: Gil
authors.forename: Jong-Oh
authors.initials: JO
authors.lastname: Yang
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Lee
authors.forename: Ho-Yeon
authors.initials: HY
authors.lastname: Song
authors.forename: Sae-Yong
authors.initials: SY
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives* / Q000506:poisoning; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013501:Surface-Active Agents / Q000506:poisoning*; D000097797:Glyphosate
chemical_list: D005998:Glycine; D006540:Herbicides; D013501:Surface-Active Agents; D000097797:Glyphosate