Successful Management of Acute Kidney Injury in a case of Herbicide 2,4 Dichlorophenoxy Acetic acid Poisoning

Abstract

Introduction: The compound 2,4 Dichlorophenoxyacetic acid (2,4-D) is present in most combinations of herbicides and is widely used by farmers in India, especially against weeds in cereal crops. Few self-poisoning cases have been reported worldwide, with guarded prognosis in most cases. Inadequate history regarding deliberate intoxication, indistinct clinical presentation, and unavailability of diagnostic facilities to detect and estimate the agent make it a significant concern in poisoning as it mimics one of the commonest poisoning which is organophosphorus poisoning. The therapy and management of this poisoning as well as prognosis of patients are not well described due to the paucity of cases in published literature.Case report: We present a case of 2,4-D poisoning with a successful clinical outcome and highlight the challenges faced in management. Our patient (A 41-year-old farmer) had a stormy clinical course in the hospital with acute kidney injury developing after a few days; he received supportive therapy along with renal replacement therapy in the form of hemodialysis. He however recovered completely and was well at follow-up. We also review the optimum management of this condition so that emergency medicine physicians and allied health personnel involved in caring for these patients can manage this effectively.Discussion: The toxicity of 2,4 D poisoning mimics the common organophosphorus poisoning in terms of symptoms. Nephrotoxicity has been described mainly due to tubular toxicity though this may manifest later in the course of hospitalization. Early initiation of alkaline diuresis not only augments the elimination of toxins but also prevents nephrotoxicity. The worsening toxin-induced acute kidney injury/acute renal failure should be promptly managed by hemodialysis, as it also helps in the elimination of 2,4-D.Conclusion: 2, 4-D poisoning remains a significant clinical challenge due to its non-specific presentation. This article contributes to the limited available literature on this potentially fatal condition highlighting the successful management of a severe case through a multi-modal approach involving alkaline diuresis, hemodialysis, and potentially corticosteroids. Further research is needed to elucidate the pathophysiology of 2,4-D toxicity and to develop specific antidotes.