Management of 2, 4- Dichlorophenoxyacetic Acid Intoxication by Hemodialysis: A Case Report

Background: The herbicide 2, 4-dichlorophenoxyacetic acid (2, 4-D) can cause moderate to lethal poisoning. Although urine alkalization has been recommended as the main treatment, hemodialysis (HD) may be more effective in severe cases. Case: On 24th June 2014, a 53- year-old man ingested a high amount of 40% 2, 4-D. He suffered from mouth and epigastric burning sensation, vomiting and nausea. He was treated, in Emam Reza’s Hospital of Mashhad University Of Medical Sciences, Mashhad , Iran, with maintenance daily fluid infusion plus 10 meq/L NaHCO3. Up to 9 hours after exposure, he became progressively stuporous. He developed diarrhea and hypotension, BP=100/60, unresponsive to volume replacement therapy. He received regular hemodialysis (HD) with bicarbonate for three hours. At the end of HD, his blood pressure rose to 110/70 and the level of consciousness began to improve. Four hours later, he was fully conscious with stable blood pressure (130/80 mmHg). Conclusion: HD may be an effective, safe and fast method for 2, 4-D high dose intoxication induced coma.