Continuous renal replacement therapy in a patient with cardiac arrest after glyphosate-surfactant herbicide poisoning

Intractable hypotension is a major cause of death after glyphosate-surfactant herbicide poisoning. However, there is no specific treatment besides conservative care. Herein, we report a patient poisoned by glyphosate-surfactant herbicide experiencing cardiac arrest but was successfully resuscitated and treated with continuous venovenous haemodiafiltration (CVVHDF). The 60-year-old patient was brought to our emergency department after ingesting glyphosate-surfactant herbicide. He developed pulmonary oedema, severe metabolic acidosis (pH 6.960), and hyperkalaemia (serum potassium 8.8 mmol/L). Although he experienced cardiac arrest for about 12 minutes, the use of CVVHDF improved the metabolic acidosis and hyperkalaemia, and finally stabilised his vital signs. He regained an alert mental state after therapeutic hypothermia. CVVHDF, which is a better tolerated renal replacement therapy than haemodialysis in haemodynamically unstable patients, should be considered in glyphosate-surfactant poisoned patients of intractable hypotension with severe metabolic acidosis or hyperkalaemia. (Hong Kong j.emerg.med. 2012;19:214-217)