Glyphosate-surfactant Herbicide Research Articles

Clinical characteristics of acute kidney injury in patients with glyphosate surfactant herbicide poisoning.

In this study, we investigated the clinical characteristics of acute kidney injury (AKI) in patients with glyphosate surfactant herbicide (GSH) poisoning. This study was performed between 2008 and 2021 and included 184 patients categorized into the AKI (n = 82) and nonAKI (n = 102) groups. The incidence, clinical characteristics, and severity of AKI were compared between the groups based on the Risk of renal dysfunction, Injury to the kidney, Failure or Loss of kidney function, and End-stage kidney disease (RIFLE) classification. The incidence of AKI was 44.5%, of which 25.0%, 6.5%, and 13.0% of patients were classified into the Risk, Injury, and Failure categories, respectively. Patients in the AKI group were older (63.3 ± 16.2 years vs. 57.4 ± 17.5 years, p = 0.02) than those in the non-AKI group. The length of hospitalization was longer (10.7 ± 12.1 days vs. 6.5 ± 8.1 days, p = 0.004) and hypotensive episodes occurred more frequently in the AKI group (45.1% vs. 8.8%, p < 0.001). Electrocardiographic (ECG) abnormalities on admission were more frequently observed in the AKI group than in the non-AKI group (80.5% vs. 47.1%, p < 0.001). Patients in the AKI group had poorer renal function (estimated glomerular filtration rate at the time of admission, 62.2 ± 22.9 mL/min/1.73 m2 vs. 88.9 ± 26.1 mL/min/1.73 m2 , p < 0.001) on admission. The mortality rate was higher in the AKI group than in the non-AKI group (18.3% vs. 1.0%, p < 0.001). Multiple logistic regression analysis showed that hypotension and ECG abnormalities upon admission were significant predictors of AKI in patients with GSH poisoning. The presence of hypotension on admission may be a useful predictor of AKI in patients with GSH intoxication.

Clinical Characteristics of AKI in Patients With Glyphosate Surfactant Herbicide Poisoning

Clinical Characteristics of AKI in Patients With Glyphosate Surfactant Herbicide Poisoning

Cellular injury leading to oxidative stress in acute poisoning with potassium permanganate/oxalic acid, paraquat, and glyphosate surfactant herbicide

Previous studies on human acute kidney injury (AKI) following poisoning with potassium permanganate/oxalic acid (KMnO4/H2C2O4), paraquat, and glyphosate surfactant herbicide (GPSH) have shown rapid and large increases in serum creatinine (sCr) that cannot be entirely explained by direct nephrotoxicity. One plausible mechanism for a rapid increase in sCr is oxidative stress. Thus, we aimed to explore biomarkers of oxidative stress, cellular injury, and their relationship with sCr, after acute KMnO4/H2C2O4, paraquat, and GPSH poisonings. Serum biomarkers [sCr, creatine (sCn), cystatin C (sCysC)] and urinary biomarkers [cytochrome C (CytoC), 8-isoprostane (8-IsoPs)] were evaluated in 105 patients [H2C2O4/KMnO4 (N = 57), paraquat, (N = 21), GPSH (N = 27)] recruited to a multicenter cohort study. We used area under the receiver operating characteristics curve (AUC-ROC) to quantify the extent of prediction of moderate to severe AKI (acute kidney injury network stage 2/3 (AKIN2/3)). Patients with AKIN2/3 showed increased levels of CytoC. Early high CytoC predicted AKIN2/3 in poisoning with KMnO4/H2C2O4 (AUC-ROC4−8h: 0.81), paraquat (AUC-ROC4−8h: 1.00), and GPSH (AUC-ROC4−8h: 0.91). 8-Isoprostane levels were not significantly elevated. Reduced sCn and increased sCr/sCn ratios were observed for 48 h post KMnO4/H2C2O4 ingestion. Paraquat exhibited a similar pattern (N = 11), however only 3 were included in our study. Increased CytoC suggests there is mitochondrial injury coupled with energy depletion. The increased sCr within 24 h could be due to increased conversion of cellular creatine to creatinine during the process of adenosine triphosphate (ATP) generation and then efflux from cells. Later increases of sCr are more likely to represent a true decrease in kidney function.

Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department.

This study aimed to identify whether quick sequential organ failure assessment (qSOFA) performed immediately upon arrival can predict the outcome of patients with glyphosate surfactant herbicide (GlySH) poisoning. Adult patients with GlySH poisoning between January 2006 and April 2017 were included in this retrospective observational study. The qSOFA score (respiratory rate ≥22 breaths per minute, systolic blood pressure <100 mm Hg, and altered mental status) was assessed immediately upon arrival at the emergency department. The primary outcome was in-hospital mortality, and the secondary outcomes were life-threatening complications and organ injury. Of the 150 patients who ingested GlySH, 14 (9.3%) died. The qSOFA score was significantly higher in the non-survival group (P < 0.001). qSOFA (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.41-5.76) was independently associated with in-hospital mortality. The area under curve value of qSOFA was 0.841 (95% CI, 0.772-0.895). As qSOFA score increased from 0 to 3, the in-hospital mortality significantly increased (P < 0.001). The frequency of life-threatening complications, including organ injury, increased as the qSOFA score increased from 0 to 3 (P < 0.001). The qSOFA score measured upon arrival shows good prognostic performance in patients with GlySH poisoning. Moreover, the qSOFA may predict the development of life-threatening complications including organ injury. Thus, more attention should be paid to patients with GlySH poisoning with higher qSOFA scores.

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning.

This study aimed to investigate whether the quick Sequential Organ Failure Assessment (qSOFA) score at emergency department (ED) presentation can help improve the risk assessment of glyphosate-surfactant herbicide (GlySH) poisoning complications. A total of 150 patients presenting with acute glyphosate herbicide ingestion were enrolled in this retrospective observational study. The qSOFA scores at presentation, ΔqSOFA (calculated by subtracting the worst qSOFA score from 1 hr after admission from the qSOFA score at presentation), baseline characteristics, clinical courses and outcome were collected and analysed. A total of 41 patients had life-threatening complications (27.3%), and 14 patients died (9.3%). Patients with a qSOFA score of 0 at presentation had a 1.5% incidence rate of complications. As the qSOFA score at presentation increased from 1 to 3, the rate of life-threatening complications significantly increased from 29.6% to 100%. Patients with a ΔqSOFA of 1 had a higher frequency of complications than did patients with a ΔqSOFA of 0. The qSOFA score (OR: 8.39, 95% CI: 3.51-26.67) and ΔqSOFA (OR: 27.60, 95% CI: 3.87-575.67) were associated with the development of life-threatening complications in the multivariate analysis. The qSOFA score showed high sensitivity (97.56%), and the ΔqSOFA score showed high specificity (99.08%). The values of area under the curve were significantly higher in the models using the qSOFA and ΔqSOFA than they were in the models using previously known prognostic factors (p < 0.01). The clinician should pay more attention to patients with high qSOFA scores at presentation or an increase in the qSOFA score 1 hr after admission.

Glyphosate Surfactant Herbicide Toxicosis in a Dog with Hindlimb Paresis and Urinary Incontinence

Glyphosate Surfactant Herbicide Toxicosis in a Dog with Hindlimb Paresis and Urinary Incontinence

Glyphosate-surfactant herbicide poisoning in domestic animals: an epidemiological survey

Veterinary RecordVolume 176, Issue 16 p. 413-413 Research Glyphosate-surfactant herbicide poisoning in domestic animals: an epidemiological survey C. Cortinovis DVM, PhD, Corresponding Author C. Cortinovis DVM, PhD cristina.cortinovis@unimi.it Department of...

Hemodialysis clearance of glyphosate following a life-threatening ingestion of glyphosate-surfactant herbicide

Context. 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. Case details. 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. Discussion. 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.

Heart rate–corrected QT interval predicts mortality in glyphosate-surfactant herbicide–poisoned patients

BackgroundGlyphosate-surfactant herbicide is promoted by the manufacturer as having no risks to human health. Glyphosate surfactant has recently been used with increasing frequency in suicide attempts, so clinical toxicologists occasionally encounter cases of severe systemic toxicity. The purpose of this study was to identify the early predictive factors of patients at risk for mortality and the usefulness of the corrected QT interval (QTc interval) for predicting mortality from glyphosate-surfactant intoxication. MethodsThis was a retrospective cohort study conducted from January 2005 to December 2012. A total of 153 patients with acute glyphosate-surfactant ingestion were included. To identify the predictive factors for mortality, objective variables easily assessed at presentation including previously reported predictive factors for mortality and severity were retrospectively analyzed for their association with mortality using univariate and multiple logistic analyses. ResultsThe average age of the patients was 56 years (range, 19-93 years). Of the 153 patients, 19 (12.4%) died. The most common abnormal electrocardiogram findings were prolonged QTc interval followed by intraventricular conduction delay and first-degree atrioventricular block. Nonsurvivors had a significantly more prolonged QTc interval when compared with that of survivors (survivors: 453.4 ± 33.6 milliseconds vs nonsurvivors: 542 ± 32.0 milliseconds, P < .001). Corrected QT interval and age were associated with a significantly increased risk of death in a multiple logistic regression. In a receiver operating curve analysis, the QTc interval had significant discriminatory power. ConclusionProlonged QTc interval seems to be a useful prognostic factor for mortality in patients intoxicated with glyphosate-surfactant herbicide.

Pathological and Toxicological Findings in Glyphosate-Surfactant Herbicide Fatality

Glyphosate herbicide is promoted by the manufacturer as having no risks to human health, with acute toxicity being very low in normal use. In Thailand, however, poisoning from glyphosate agricultural herbicides has been increasing. A case of rapid lethal intoxication from glyphosate-surfactant herbicide involved a 37-year-old woman, who deliberately ingested approximately 500 mL of concentrated Roundup formulation (41% glyphosate as the isopropylamine salt and 15% polyoxyethylene amine; Mosanto Company). The postmortem examination revealed that the stomach contained 550 mL of yellow fluid. The gastric mucosa of anterior fundus revealed hemorrhage and the small intestines had marked dilatation and thin walls. We used the high-performance liquid chromatography method for determination of serum and gastric content levels of glyphosate. The glyphosate levels of serum and gastric content were 3.05 and 59.72 mg/mL, respectively. Toxic effects of polyoxyethylene amine and Roundup were caused by their ability to erode tissues including mucous membranes and linings of the gastrointestinal and respiratory tracts. A mild degree of pulmonary congestion and edema was observed in both lungs. We proposed that the characteristic picture of microvesicular steatosis of the hepatocytes, seen predominantly in centrilobular zones of the liver, resembled drug-induced hepatic toxicity or secondary hypoxic stress.

Fatal Poisoning with Glyphosate-Surfactant Herbicide

A 29-year-old man was admitted following deliberate ingestion of approximately 300 mL of ‘Roundup Ace,’ a herbicide containing glyphosate. On presentation, he was agitated and required intubation and admission to ICU. He developed severe and persistent lactic acidosis, hyperkalaemia, hypotension, torrential watery diarrhoea and abdominal distension in the first 24 hours. The patient was supported with a continuous noradrenaline infusion and continuous veno-venous haemodiafiltration. The clinical course was further complicated by cardiac arrhythmias and an episode of cardiac arrest. By day three, he had bone-marrow, liver and worsening respiratory failure. There was no hope of recovery; therefore, noradrenaline was discontinued, and the patient died 15 minutes later. Glyphosate-surfactant herbicide (GlySH) is a general-purpose herbicide with no anticholinesterase effect and no organophosphate-like CNS effects. GlySH intoxication has a case fatality rate of between 3.2% and 29.3%. There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. Early renal replacement therapy may improve prognosis but there is no evidence to support this. There is one published case of a patient who survived severe GlySH poisoning following administration of intravenous fat emulsion. Glyphosate-surfactant herbicide, commercially known as ‘Roundup’ is a widely available herbicide commonly used in both professional and domestic settings. This is a case of a young man who deliberately ingested GlySH at home and rapidly developed multi-organ failure, culminating in his death.

Predicting acute complicated glyphosate intoxication in the emergency department

Background. Glyphosate herbicide intoxication results in a range of mortality and morbidity, depending on patients' factors. Predicting which patient will need intensive medical treatment might help reduce mortality by providing prompt treatment, as well as triage those patients not likely to develop complications. Thus, we sought to identify independent factors that could predict which patient will develop subsequent medical complications. Methods. Seventy-six patients presenting with acute glyphosate herbicide ingestion at Chonnam National University Hospital were enrolled in this retrospective study. To identify the predictive factors for complications, objective variables easily assessed at presentation including previously reported predictive factors for mortality, such as age, vital signs, X-ray abnormalities, and laboratory findings, were analyzed by univariate and multivariate stepwise logistic regression analyses. Results. Of the 76 patients, 32 (42.1%) had medical complications and 2 (2.6%) died. Metabolic acidosis was the most common medical complication. Whereas metabolic acidosis, respiratory failure, hypotension, acute kidney injury, hyperkalemia, and seizures developed within 24 h, acute pancreatitis occurred a few days after the ingestion. The univariate analysis showed that an advanced age, amount ingested >100 mL, X-ray abnormalities, elevated amylase, alanine aminotransferase (ALT), and blood nitrogen urea were significant factors. However, the multivariate analysis showed that advanced age, elevated ALT, and X-ray abnormalities were independent factors associated with serious complications and the need for intensive medical treatment. Conclusions. The results of this study showed that age > 50 years, X-ray abnormalities, and ALT > 40 U/L were significant predictive factors for complications in patients with glyphosate surfactant herbicide poisoning; patients with these findings might require admission to the intensive care unit.

Use of a lipid emulsion in a patient with refractory hypotension caused by glyphosate-surfactant herbicide

Context. Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE). Case details. A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered. Conclusion. IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.

The epidemiology of glyphosate-surfactant herbicide poisoning in Taiwan, 1986–2007: a poison center study

Background. Glyphosate-surfactant herbicide (GlySH) is widely used in agriculture and has been associated with numerous toxicities following oral ingestion. However, there are many controversies with regard to the exact causes and determinants of developing severe/death outcome after exposure to GlySH. Methods. We conducted an analysis of all GlySH exposures reported to the Taiwan National Poison Control Center between 1986 and 2007. Patients' baseline characteristics and clinical data were reviewed and analyzed. Results. A total of 2,186 patients were eligible for analysis. Most of the exposures were related to oral ingestion (n = 2,023, 92.5%) and attempted suicide (n = 1,631, 74.6%). The mean age of exposure was 42.8 ± 18.6 years. One hundred patients developed severe effects and 146 patients died following oral GlySH exposure, resulting in a case fatality rate of 7.2%. Shock (n = 85, 58.2%) and respiratory failure (n = 34, 23.3%) accounted for most fatalities. Four out of eight patients with injection exposure manifested severe (n = 3) or fatal outcome (n = 1). In a multivariate logistic regression analysis, increasing age, larger amount of exposure, longer elapsed time to presentation, attempted suicide, receipt of atropine therapy, and being exposed in certain calendar years were positively associated with the severity of poisoning following oral GlySH exposure. Conclusion. Age, ingested amount, delayed presentation, and reason for exposure were likely to be determinants of the severity of GlySH exposure. Because shock is the major cause of death and usually develops early after GlySH exposure, prompt fluid replacement therapy seems critical in the initial management of such exposures. Patients' airway should also be secured to avoid aspiration and subsequent respiratory failure.

Acute pancreatitis caused by severe glyphosate-surfactant oral intoxication

Glyphosate-surfactant is used extensively as a nonselective herbicide. Suicidal attempts with glyphosate-surfactant herbicide (GlySH) has been encountered with increasing frequency. The effect of GlySH intoxication often involves multiple systems. We report a case of a severely intoxicated man who developed chemical pneumonitis and respiratory failure after suicidal ingestion of GlySH. Acute pancreatitis, which was never covered by any previous case reports, developed in the first day, and the symptom persisted for 10 days during hospitalization.

Clinical presentations and prognostic factors of a glyphosate-surfactant herbicide intoxication: a review of 131 cases.

Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate-surfactant herbicide (GlySH) intoxication has been encountered with increasing frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. This was a retrospective study of 131 GlySH-intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were abstracted, looking for predictors of mortality. The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean +/- SEM time to death was 2.8 +/- 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x-ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance.

Laryngeal survey in glyphosate intoxication: a pathophysiological investigation.

Respiratory aspiration is a serious potential complication of glyphosate-surfactant herbicide intoxication. From October 1, 1992 to June 30, 1996, we performed laryngeal evaluations in 53 cases to investigate the possible pathophysiological mechanism of glyphosate intoxication. There were 36 cases with significant laryngeal injury. The blood WBC count were significantly higher and the hospital stays were significantly longer in patients with laryngeal injury, when compared with patients with no laryngeal injury (Student t-test, P < 0.005). Laryngeal injury was strongly correlated with aspiration pneumonitis (mean 2 = 4.449, P < 0.05). We concluded that laryngeal injury may be the major cause of aspiration that leads to some degree of morbidity and mortality, following concentrated glyphosate-surfactant herbicide intoxication. Laryngeal survey may be indicated in cases of glyphosate-surfactant intoxication, to evaluate the severity of mucosal injury, and to apply adequate supportive management as early as possible to prevent from aspiration complications and even mortality.

Environmental Degradation of Polyacrylamides

The environmental fate of a polyacrylamide thickening agent (PATA), formulated without and with a glyphosate-surfactant herbicide (GH), was examined under various environmental situations: formulation in surface water and ground water, volatility, and soil mobility. Environmental Fate of PATA in Surface Water and Ground Water:PATA was formulated at four concentrations in distilled–deionized water, three surface water samples, and two ground water samples, without and with a GH. Solutions were placed in glass bottles, covered with plastic wrap, and exposed to environmental (outdoor) conditions for 6 weeks. Acrylamide and ammonium concentration, pH, and bacterial and fungal populations were measured weekly. All solutions in this portion of the study had a homogeneous milky appearance but by the conclusions of the study were nearly transparent. The results of this study suggest that polyacrylamide can degrade to acrylamide under environmental conditions. Statistically, there was no linear correlation between the various parameters measured. Volatility:PATA was formulated without and with GH. Each solution plus an acrylamide standard (positive control) was placed in a glass beaker and exposed to environmental (outdoor) conditions for 6 days. Acrylamide concentration, ammonium concentration, pH, and solution volume were measured daily. Acrylamide and ammonium concentrations increased during the study in all formulations, except when solutions evaporated to dryness. pH did not change greatly over the course of the study for these samples. Those solutions containing PATA had a homogeneous milky appearance but by the conclusions of the study were nearly transparent. This suggests a physical structural change in the polymer. Soil Mobility:PATA formulated with GH was also applied to soil columns and soil boxes containing sand, Eudora sandy loam, Eudora sandy clay, and Kohola silt loam. Acrylamide could be detected by Day 2 in all soil columns. Acrylamide could not be detected in the runoff of any of the soil boxes.

Environmental Degradation of Polyacrylamides. 1. Effects of Artificial Environmental Conditions: Temperature, Light, and pH

A polyacrylamide thickening agent (PATA) was formulated at four concentrations in distilled–deionized water, without and with a glyphosate–surfactant herbicide (GH). Over a 6-week period, these mixtures were exposed to various controlled temperature and light conditions. Acrylamide concentration, ammonium concentration, and pH were measured at weekly intervals to assess the degradation of polyacrylamide and acrylamide. Satellite studies were conducted to examine the effect of altered pH on solutions of PATA (i.e., does pH promote polyacrylamide depolymerization?) and GH binding to amine groups (i.e., protection from degradation). The results of these studies suggest that polyacrylamide can degrade to acrylamide by thermal and photolytic effects, that changes in pH do not promote the depolymerization of polyacrylamide, and that GH does protect polyacrylamide and acrylamide from environmental degradation. Statistically there was no linear correlation between the various parameters measured.

Taiwan National Poison Center Survey Of Glyphosate - Surfactant Herbicide Ingestions

Between January, 1986 and September, 1988, the Taiwan National Poison Center recorded 97 telephone consultations (49 male, 48 female) on cases of ingestion of glyphosate-surfactant herbicide concentrate containing the isopropylamine salt of glyphosate (N-phosphonomethyl glycine, CAS 1071-83-6) and a non-ionic tallow amine surfactant. Eleven of the cases resulted in fatalities, all among those attempting suicide. The average amount ingested by survivors was 120 +/- 112 mL and by nonsurvivors was 263 +/- 100 mL (p less than or equal to 0.0001). The average age of survivors was 35 +/- 15 years compared to 54 +/- 11 years for fatalities (p less than or equal to 0.0002). Irritation of the oral mucous membrane and gastrointestinal tract was the most frequently reported effect. Other effects recorded were pulmonary dysfunction, oliguria, metabolic acidosis, hypotension, leukocytosis and fever. Fourteen patients received either atropine or pralidoxime plus atropine despite the fact that glyphosate does not inhibit acetylcholinesterase. Thirteen percent of patients received a urine test for paraquat or treatment customarily used for paraquat ingestion, possibly reflecting similar initial presentations following ingestion of these two herbicides. Laboratory differentiation is essential if any doubt exists about which herbicide was ingested. Patients ingesting large volumes of concentrated glyphosate-surfactant herbicide formulations require close observation and supportive treatment.