Abstract
Introduction: Roundup® is a herbicide widely used in Japan in gardening and agriculture. When ingested, Roundup is highly toxic, but gastrointestinal decontamination, including gastric lavage, is not routinely performed after ingestion. Endoscopy may be useful in managing individuals with liquid herbicide poisoning, by identifying gastric residual contents, assessing mucosal damage and retrieving herbicide directly by aspiration. Case report: A 73 year old, 40 kg female with a history of depression was transported to our emergency room by ambulance 1 h after attempting suicide by ingesting 100 ml Roundup, which contains 48% glyphosate-potassium, and 52% surfactant and water. This volume was below a fatal dose (<5000 mg/kg), but may have caused organ dysfunction and mucosal damage. After confirming respiratory and circulatory stability and after obtaining informed consent from the patient, endoscopy (XQ 260; Olympus, Tokyo, Japan) was performed in the emergency room to retrieve residual herbicide. About 80 ml of herbicide in the stomach were aspirated endoscopically with only mild erosion observed in the mucosa of the stomach. The patient was able to resume oral intake 2 days after endoscopy and was discharged without any complications on day 5. Conclusion: Endoscopy may be useful in cases of liquid poisoning including, Roundup, both to determine the amount of residual toxin and to remove it from the stomach.
Highlights
Roundup® is a herbicide widely used in Japan in gardening and agriculture
The toxicity of herbicide derives from the glyphosate and surfactant [1,2], with mortality rates following its intentional ingestion reported to range from 3.2% to 29% [3,4]
Endoscopy in patients poisoned with liquid herbicide may be useful for assessing gastric residual contents and mucosal damage, as well as for direct retrieval of the toxic agent by aspiration
Summary
Roundup® is an herbicide widely used in Japan for gardening and agriculture. Many preparations of this herbicide are available, containing various amounts of glyphosate (N-[phosphonomethyl] glycine), surfactant, and water. Endoscopy in patients poisoned with liquid herbicide may be useful for assessing gastric residual contents and mucosal damage, as well as for direct retrieval of the toxic agent by aspiration. A 73 year old, 40 kg female with a history of depression was transported to our emergency room by ambulance 1 h after attempting suicide by ingestion of 100 ml of the herbicide Roundup®, containing 48% glyphosate-potassium, and 52% surfactant and water. At admission, her blood pressure was 177/85 mmHg, her heart rate was 60 beats/min, her respiratory rate was 20 breaths/min and her temperature was 36.4°C.
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