title: Hemodialysis clearance of glyphosate following a life-threatening ingestion of glyphosate-surfactant herbicide.
abstract: BACKGROUND
  Ingestion of glyphosate-surfactant herbicides (GlySH) can result in acute kidney injury, electrolyte abnormalities, acidosis, cardiovascular collapse, and death. In severe toxicity, the use of hemodialysis is reported, but largely unsupported by kinetic analysis. We report the dialysis clearance of glyphosate following a suicidal ingestion of a glyphosate-containing herbicide.
  
  
  METHODS
  A 62-year-old man was brought to the emergency department (ED) 8.5 h after drinking a bottle of commercial herbicide containing a 41% solution of glyphosate isopropylamine, in polyoxyethyleneamine (POEA) surfactant and water. He was bradycardic and obtunded with respiratory depression necessitating intubation and mechanical ventilation. Initial laboratory results were significant for the following: pH, 7.11; PCO2, 64 mmHg; PO2, 48 mmHg; potassium, 7.8 mEq/L; Cr 3.3, mg/dL; bicarbonate, 22 mEq/L; anion gap, 18 mEq/L; and lactate, 7.5 mmol/L. Acidosis and hyperkalemia persisted despite ventilation and fluid resuscitation. The patient underwent hemodialysis 16 h post ingestion, after which he demonstrated resolution of acidosis and hyperkalemia, and improvement in clinical status. Serum glyphosate concentrations were drawn prior to, during, and after hemodialysis. The extraction ratio and hemodialysis clearance were calculated to be 91.8% and 97.5 mL/min, respectively.
  
  
  CONCLUSIONS
  We demonstrate the successful clearance of glyphosate using hemodialysis, with corresponding clinical improvement in a patient with several poor prognostic factors (advanced age, large volume ingested, and impaired consciousness). The effects of hemodialysis on the surfactant compound are unknown. Hemodialysis can be considered when severe acidosis and acute kidney injury complicate ingestion of glyphosate-containing products.
authors.affiliation: Poison and Drug Information Service, Alberta Health Services , Calgary, Alberta , Canada.
authors.forename: F M
authors.initials: FM
authors.lastname: Garlich
authors.forename: M
authors.initials: M
authors.lastname: Goldman
authors.forename: J
authors.initials: J
authors.lastname: Pepe
authors.forename: L S
authors.initials: LS
authors.lastname: Nelson
authors.forename: M J
authors.initials: MJ
authors.lastname: Allan
authors.forename: D A
authors.initials: DA
authors.lastname: Goldstein
authors.forename: D S
authors.initials: DS
authors.lastname: Goldfarb
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
mesh_terms: D000138:Acidosis / Q000139:chemically induced; D001774:Blood Chemical Analysis; D004562:Electrocardiography; D005998:Glycine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000506:poisoning; D006439:Hemodynamics / Q000502:physiology; D006540:Herbicides / Q000493:pharmacokinetics* / Q000506:poisoning*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy; D013406:Suicide, Attempted; D014474:Unconsciousness / Q000139:chemically induced; D000097797:Glyphosate
chemical_list: D005998:Glycine; D006540:Herbicides; D000097797:Glyphosate