What is the treatment for glyphosate (herbicide) poisoning after consumption?

Treatment for Glyphosate Herbicide Poisoning

The treatment for glyphosate poisoning should focus on immediate decontamination, supportive care, and management of specific complications, as there is no specific antidote available. 1

Initial Management

• Immediately contact a Poison Control Center (1-800-222-1222) for expert advice on management of glyphosate poisoning 2
• Remove all contaminated clothing and avoid self-contamination when handling the patient 3
• For dermal exposure, perform skin decontamination with soap and water 1
• For eye exposure, flush with large amounts of water to prevent corneal injury 3

Gastrointestinal Decontamination

• For recent ingestions, consider activated charcoal administration (20-30g mixed in at least 8 ounces of liquid) if the patient presents within 1 hour of ingestion and is alert 2
• Gastric lavage should be considered for significant ingestions, but care must be taken to avoid neutralizing acid-base reactions that could further damage the gastric mucosa 4
• Do not give anything by mouth unless advised by poison control or emergency medical personnel 3

Supportive Care

• Manage airway, breathing, and circulation according to standard protocols 3
• Early endotracheal intubation is recommended for patients with respiratory distress or decreased level of consciousness 5
• Provide aggressive intravenous fluid resuscitation for hypotension, which is common in severe glyphosate poisoning 1, 6
• Monitor for and treat metabolic acidosis, which may require sodium bicarbonate administration 1
• Monitor renal and hepatic function, as impairment is common in severe poisoning 1

Management of Specific Complications

• For cardiovascular complications (hypotension, arrhythmias):

  • Administer vasopressors if hypotension is unresponsive to fluid resuscitation 6
  • Monitor cardiac rhythm and treat arrhythmias according to standard protocols 1

• For renal complications:

  • Consider hemodialysis for severe cases with acute kidney injury 1
  • Intravenous lipid emulsion therapy may be beneficial in severe cases, as suggested by case reports showing reduced hypotension and fewer arrhythmias compared to historical controls 5

• For gastrointestinal complications:

  • Provide acid suppression therapy (proton pump inhibitors or H2 blockers) and mucosal protection for erosive gastrointestinal effects 4
  • Monitor for gastrointestinal hemorrhage, which occurs in approximately 8% of intentional ingestions 6

• For pulmonary complications:

  • Provide supplemental oxygen and ventilatory support as needed 1
  • Monitor for pulmonary edema, which may occur in severe cases 6

Prognosis and Monitoring

• The amount ingested correlates with the likelihood of serious systemic effects or death 1
• Ingestion of >85 mL of concentrated formulation (41% glyphosate) is likely to cause significant toxicity in adults 1
• Advanced age is associated with poorer prognosis 1
• Deaths typically occur within hours of ingestion and are characterized by hypotension unresponsive to fluids or vasopressors, often with pulmonary edema 6

Long-term Follow-up

• Monitor for delayed complications such as pyloric obstruction, which may develop months after acute poisoning 4
• Continue acid suppression and mucosal protection therapy for an extended period to promote gastric mucosal repair 4

Important Considerations

• The toxicity of glyphosate formulations is complicated by the presence of surfactants like polyoxyethyleneamine (POEA), which may contribute significantly to the overall toxicity 1
• Commercial formulations vary in concentration from 1% (domestic use) to 41% or more (professional use) 1
• There is currently no specific antidote for glyphosate poisoning 7