Prediction of Severity in Glyphosate Poisoning by Ingestion

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 46; no. 5; p. 414
• Main Authors: Labricciosa, F M, Butera, R, Lonati, D, Giampreti, A, Bigi, S, Locatelli, C, Manzo, L
• Format: Journal Article
• Language: English
• Published: 01.06.2008
• ISSN: 1556-3650

After glyphosate ingestion, patients may present to the Emergency Department (ED) with a wide range of symptoms, not necessarily reflecting the potential severity of the poisoning. Objective: To evaluate early indicators of severity and clinical evolution in glyphosate poisoning by ingestion. Methods: A retrospective analysis of all cases of glyphosate ingestion referred to the Pavia Poison Center over a period January 2002 - September 2007 was performed; among them, human cases with confirmed poisoning were included in the study. Three potential indicators were evaluated at ED admission for their ability to predict subsequent clinical worsening: ingestion of large amounts (>200 ml) of glyphosate, presence of leukocytosis, increase in pancreatic enzymes. According to the specific criteria proposed in the literature for glyphosate poisoning (1,2), the severity of poisoning (PS) was assessed at admission and during the clinical course, moreover the difference between initial and overall poisoning severity (delta-PS) and the time elapsed between ED evaluation and worsening were calculated. Results: Twenty-five patients met the inclusion criteria. At admission, 10 patients were asymptomatic, 8 were graded as mild, 5 as moderate and 2 as severe. Nine patients worsened (delta-PS greater than or equal to 1) after 6.7 plus or minus 6.5 hours (range 0.5-19.7 hours), 2 from asymptomatic to moderate, 3 from mild to moderate, and 4 from moderate to severe; they all had at least one positive indicator of clinical worsening. Among the 16 patients who did not worsen (delta-PS=0), 14 (87.5%) were negative for all the parameters evaluated, whereas 2 cases, both of increased severity since ED presentation, had 2 and 3 positive indicators respectively. Conclusion: In glyphosate poisoned patients, ingestion of large amounts, leukocytosis and increased pancreatic enzymes at admission may be useful in predicting subsequent worsening, possibly allowing choice in advance of the proper clinical management.