Rhabdomyolisis after acute skin exposure to a herbicide. Report of two Clinical casesJ. C. Piola (1); D.B. Prada (1); D.C. Ezpeleta (1)
(1) Servicio de Toxicología del Sanatorio
de Niños, Rosario Acta Toxicológica Argentina (1999) 7 (1): 11-15
Abstract
Herbicides like dicamba are used to control broad-leaved weeds. This and others
of the fenoxicetic family are formulated as ester or salts,
sometimes containing up to 50% active ingredient. Muscle weakness
and peripheral neuropathy have been reported after occupational
exposure. Dicamba is supposed to have low level acute toxicity
in man.
We present the observations of two patients
admitted to the emergency room of Hospital de Emergencias
Clemente Alvarez, Rosario, Argentina, in September 1993. Both
patients (18 and 20 year old males) who live in a rural area
of Zavalla, Santa Fe, explained they had crossed a wheat field
fumigated with MISIL (dicamba dimethylamine salt) fifteen
days ago. They got their skin and clothes wet and did not
wash themselves then nor in the next few days. They presented
similar symptoms: severe muscle spasms, profuse diaphoresis
and weakness. Creatine phosphokinase level was markedly raised
and others muscle enzymes like lactic dehydrogenase and glutamic
and piruvic oxaloacetic transaminasa were all significantly
raised indicating rhabdomyolisis. One patient had oliguric
acute renal failure and he was treated with hemodialysis.
Both made small progress in evolution (30 and 40 days). 24-hour
urine sample were taken at the hospital admission and processed
by capillary column gas chromatography with electron-capture
detection and high-performance liquid chromatography with
cuaternary pump and adjustment diode detection. Dicamba identity
was confirmed by gas chromatography-mass spectrometry.
We discuss diagnostic difficulties, review of
pharmacokinetics of chlorinated phenoxy acid herbicides and
association between rhabdomyolisis and dicamba exposition.
Limited data about similar cases are available.
Key words: rhabdomyolisis- skin exposure-dicamba
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