Fatal endothall herbicide ingestion

Abstract

BACKGROUND: Endothall is a widely available selective serine-threonine protein phosphatase (PP2A) inhibiting herbicide and plant desiccant. We are aware of only two case reports of deliberate self-poisoning in the literature, both fatal (Allender, 1983 and Day, 1988). Hypothesis: Endothall is highly lethal in deliberate self-poisoning. METHOD(s): This is a single medical chart review. RESULT(s): A young adult patient was brought to hospital after admitting to a deliberate self-poisoning by ingestion of 50 mL of 175 g/L endothall dipotassium salt 2.5 hours previously with no co-ingestants. Family members corroborated the history and an empty bottle was presented to staff. Initially, the patient was alert and had hematemesis, abdominal pain, tachycardia, BP 100/70 mmHg, and metabolic acidosis with lactate of 4.8 mmol/L. A pantoprazole infusion and supportive care was commenced. Toxicology services advised there was no specific treatment but multi-organ failure was likely, noting previous fatalities. Thereafter, the patient deteriorated over the next few hours and became hypotensive and obtunded. Metabolic acidosis worsened with a pH 6.9 and bicarbonate 12 mmol/L, accompanied by low serum glucose, potassium, magnesium, and phosphate. Urine output dropped to almost zero and there was an acute kidney injury with a creatinine of 121 mmol/L. Despite aggressive therapies which included dialysis, noradrenaline, vasopressin, intralipid, mechanical ventilation and blood products, the patient developed acute respiratory distress syndrome, disseminated intravascular coagulopathy, and spontaneous intra-abdominal bleeding. Unfortunately, the patient arrested and died 13 hours post-ingestion. CONCLUSION(s): There is mounting evidence that deliberate endothall ingestion is highly lethal and is characterised by gastrointestinal effects followed by multi-organ dysfunction syndrome. Consideration should be given to regulating its availability.