Acute human self-poisoning with bispyribac-containing herbicide Nominee (R): a prospective observational study

Gawarammana, Indika Bandara, Roberts, Darren M., Mohamed, Fahim, Roberts, Michael S., Medley, Gregory, Jayamanne, Shaluka and Dawson, Andrew (2010) Acute human self-poisoning with bispyribac-containing herbicide Nominee (R): a prospective observational study. Clinical Toxicology, 48 3: 198-202. doi:10.3109/15563651003660000


Author Gawarammana, Indika Bandara
Roberts, Darren M.
Mohamed, Fahim
Roberts, Michael S.
Medley, Gregory
Jayamanne, Shaluka
Dawson, Andrew
Title Acute human self-poisoning with bispyribac-containing herbicide Nominee (R): a prospective observational study
Journal name Clinical Toxicology   Check publisher's open access policy
ISSN 1556-3650
1556-9519
Publication date 2010-03
Sub-type Article (original research)
DOI 10.3109/15563651003660000
Volume 48
Issue 3
Start page 198
End page 202
Total pages 5
Place of publication New York, NY, U.S.A.
Publisher Informa Healthcare
Collection year 2011
Language eng
Formatted abstract Introduction. Self-poisoning with herbicides is an important reason for hospital admission and death in Asia. Although some herbicides have a well-described toxicity profile in humans, many of the newer compounds rely on extrapolation from animal results as no published literature on clinical outcomes of human self-poisoning has been described. One example of these compounds is bispyribac, a selective herbicide used in rice and wheat cultivation that is marketed in two containers, one containing bispyribac 400 g/L with a solvent and the other the surfactant, polyethylene glycol. We present the first case series of acute human self-poisoning with an herbicide product containing bispyribac. 

Methods. Clinical data for all patients who presented with acute poisoning from a bispyribac-containing herbicide (Nominee®) to two general hospitals in Sri Lanka from June 2002 to January 2009 were collected prospectively. Admission and serial blood samples were collected from consenting patients to confirm exposure and to study the toxicokinetics of bispyribac, respectively. Results.  One hundred ten patients with a history of bispyribac ingestion presented after a median time of 4 h post-ingestion. There were three deaths at 15, 6, and 5 h post-ingestion because of asystolic cardiac arrest. All three patients had reduced Glasgow Coma Score (GCS) (3, 12, and 13, respectively) of whom the former two had co-ingested ethanol and developed tonic-clonic seizures. Admission blood sample was obtained from the former two of these patients but bispyribac was detected in only one of these patients. The other patient presented 2.5 h post-ingestion with a GCS of 12 but bispyribac was not detected. Excluding the patient with undetectable bispyribac, a conservative estimate of the case fatality ratio at 1.81% (95% confidence interval 0.32–5.8) can be made. The majority of the remaining patients had self-limiting upper gastrointestinal symptoms and eight patients had an abnormal GCS on presentation to hospital. The overall median hospital stay was 3 days. Bispyribac was not detectable on admission in 21 patients; in the remaining patients, the median plasma concentration was 50.55 μg/mL (interquartile range 1.28–116.5; n = 32). The peak concentration was noted around 3 h post-ingestion and plasma bispyribac concentration did not predict the severity of poisoning. 

Conclusion.  The majority of patients developed self-resolving symptoms and were successfully managed in rural general hospitals without transfer to larger tertiary hospitals. Patients who died developed significant poisoning within 6 h and plasma bispyribac concentrations did not appear to predict mortality. The lack of correlation between bispyribac outcomes and the available plasma concentrations may be because of exposure to nonbispyribac components or other undefined factors. Clinical outcomes from acute self-poisoning with bispyribac-containing herbicides appear to be relatively more favorable than other commonly used herbicides.
Copyright © Informa UK, Ltd.

Keyword Pesticides
Deaths
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 29 Aug 2010, 00:07:17 EST