What is the treatment for Pertilachlor poisoning?

Treatment for Pretilachlor Poisoning

For pretilachlor poisoning, the cornerstone of treatment is supportive care with gastrointestinal decontamination using activated charcoal, as pretilachlor has relatively low toxicity compared to other herbicides with a case fatality rate of zero in clinical studies. 1

Initial Management

• Gastrointestinal Decontamination:

  • Administer activated charcoal: 20-30g (3-4 heaping tablespoons) mixed in at least 8 ounces of liquid 2
  • Repeat dose if possible for maximum adsorption of toxin
  • Contact Poison Control Center immediately (1-800-222-1222) for guidance

• Supportive Care:

  • Fluid resuscitation to maintain adequate hydration
  • Monitor vital signs closely
  • Assess for and manage symptoms including:
    • Vomiting (present in 60% of herbicide poisoning cases)
    • Abdominal pain (40%)
    • Throat discomfort (26%)
    • Oral ulcers (24%) 1

Monitoring and Further Management

• Laboratory Assessment:

  • Monitor liver function tests (64% of herbicide poisoning cases show deranged liver enzymes)
  • Assess kidney function (58% develop acute kidney injury with herbicide poisoning)
  • Monitor respiratory status (30% develop respiratory distress) 1

• Specific Considerations for Pretilachlor:

  • While pretilachlor is toxic, clinical data shows it has significantly lower mortality compared to other herbicides like paraquat (0% vs 56.2% mortality) 1
  • Monitor for development of:
    • Hepatic dysfunction
    • Renal impairment
    • Respiratory complications

Advanced Interventions

• For Severe Cases:

  • If standard therapy fails or if patient develops signs of severe toxicity, consider extracorporeal treatment 3
  • Indications for extracorporeal treatment include:
    • Altered mental status
    • Development of acute respiratory distress syndrome with hypoxemia requiring supplemental oxygen
    • Failure of standard supportive measures 3

• Preferred Extracorporeal Method:

  • Hemodialysis is the preferred modality if extracorporeal treatment is needed 3, 4
  • Consider VA-ECMO only for persistent cardiogenic shock or cardiac arrest not responsive to maximal treatment measures 3

Clinical Pearls and Pitfalls

• Important Distinctions:

  • Pretilachlor is a pre-emergent herbicide with relatively lower toxicity profile compared to paraquat and glyphosate 1
  • Do not delay activated charcoal administration while waiting for laboratory confirmation

• Avoid Common Pitfalls:

  • Do not use physical restraints without adequate sedation in agitated patients 3
  • Do not delay contacting Poison Control for guidance
  • Remember that clinical status is more important than toxin levels when determining treatment intensity 3

• Prognosis:

  • Pretilachlor poisoning has shown a 0% case fatality rate in clinical studies, making it relatively safer than other herbicides 1
  • Most patients with pretilachlor poisoning can be managed successfully with supportive care and decontamination