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.

METHOD:

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%.

CONCLUSION:

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: Shukry Zawahir, Darren M Roberts, Chathura Palangasinghe, Fahim Mohamed, Michael Eddleston, Andrew H Dawson, Nick A Buckley, Lingling Ren, Gregory A Medley, Indika Gawarammana
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 47 Issue 8 Pg. 792-7 (Sep 2009) ISSN: 1556-9519 [Electronic] England
• PMID: 19663557 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Herbicides
• Oxazoles
• Propionates
• Sulfonylurea Compounds
• 1-(4,6-dimethoxypyrimidin-2-yl)-3-(2-ethoxyphenoxysulfonyl)urea
• ethyl-4,5-dihydro-5,5-diphenylisoxazol-3-carboxylate
• fenoxaprop ethyl

Topics

• Acute Disease
• Consumer Product Safety
• Drug Overdose (therapy)
• Female
• Herbicides (pharmacokinetics, poisoning)
• Hospitals, General
• Humans
• Length of Stay
• Male
• Oxazoles (pharmacokinetics, poisoning, toxicity)
• Propionates (pharmacokinetics, poisoning)
• Prospective Studies
• Risk Assessment
• Sri Lanka
• Suicide
• Sulfonylurea Compounds (pharmacokinetics, poisoning, toxicity)
• Treatment Outcome