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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.
Acknowledgments
We thank Dr. M. Suntharalingam, Dr. S.K. Kodisinhghe, and Dr. P.A.I. Wijayanayaka for their help in data collection, the hospital physicians for their assistance with the study, the medical superintendents of General Hospital Anuradhapura and Polonnaruwa for giving permission to access the medical records, SACTRC Clinical Research coordinators and Clinical Research Assistants for their support in data collection, and Dr. Gamini Manuweera (pesticide registrar of Sri Lanka) for his advice about agricultural indications for herbicides. The South Asian Clinical Toxicology Research Collaboration is funded by the Wellcome Trust/National Health and Medical Research Council International Collaborative Research Grant 071669MA. ME is a Wellcome Trust Career Development Fellow funded by grant GR063560MA.