Journal of The Korean Society of Clinical Toxicology

Original Articles

Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status: Rok Lee, Tae Yong Shin, Hyung Jun Moon, Hyun Jung Lee, Dongkil Jeong, Dongwook Lee, Sun In Hong, Hyun Joon Kim; J Korean Soc Clin Toxicol. 2023;21(2):135-142. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00018

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Abstract PDF: Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status.
Methods
This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups.
Results
There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844), 1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527–0.722).
Conclusion
The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

Association between continuous renal replacement therapy and mortality after acute herbicide (glyphosate and/or glufosinate) intoxication: propensity score matching approach: Seung Woo Lee, Won-joon Jeong, Seung Ryu, Yongchul Cho, Yeonho You, Jung Soo Park, Changshin Kang, Hong Joon Ahn, So Young Jeon, Jinwoong Lee; J Korean Soc Clin Toxicol. 2023;21(1):17-23. Published online June 30, 2023; DOI: https://doi.org/10.22537/jksct.2023.00001

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Abstract PDF: Purpose: We investigated the association between continuous renal replacement therapy (CRRT) and mortality after acute glyphosate or glufosinate intoxication.
Methods
The electronic medical records of patients with acute herbicide ingestion who were admitted to the regional emergency center of a metropolitan city in Korea from 3/1/2013 to 2/28/2022 were analyzed and reviewed retrospectively. The case group received CRRT, while the control group did not. In total, 96 patients experienced acute herbicide intoxication in the study period. Baseline characteristics were analyzed and compared between the two groups after propensity score matching. The outcome variable was mortality fitted by a Cox proportional hazard model.
Results
After full matching between cases of CRRT use and controls (patients who did not receive CRRT) using propensity scores, 96 patients (27 cases, 69 controls) were analyzed. Propensity matching yielded adequate balance (standardized mean differences <0.25) for all covariates. We fit a Cox proportional hazards model with survival as the outcome and CRRT as a factor, including the matching weights in the estimation. The estimated hazard ratio was 0.41 (95% confidence interval, 0.23–0.76; p=0.0044), indicating that CRRT reduced mortality.
Conclusion
In this propensity score-matched analysis, CRRT reduced mortality in patients who visited the hospital with acute glyphosate or glufosinate intoxication. In patients with acute herbicide poisoning with high severity calculated by the APACHE II (Acute Physiology and Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score, CRRT should be actively considered to improve the survival rate.

Inflammatory cytokines in patients with pesticide poisoning: a pilot study: Hyun Joon Kim, Wook-Joon Kim, Dong Wook Lee, Seung-Hyun Jung, Nam-Jun Cho, Samel Park, Eun Young Lee, Hyo-Wook Gil; J Korean Soc Clin Toxicol. 2022;20(1):15-21. Published online June 30, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.1.15

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Purpose: Acute pesticide poisoning is lethal and can lead to death. A few studies about the effects of acute pesticide poisoning have focused on the immune system. In the current study, we preliminarily investigated the changes in blood inflammatory cytokine levels in acute pesticide poisoning patients. Methods: In this study, we prospectively investigated the inflammatory cytokines in patients with acute pesticide poisoning. This study included patients admitted from February 2021 to November 2021 with a diagnosis of intentional poisoning by pesticide ingestion. The inflammatory cytokines measured were IFN-γ, IL-1β, IL-6, and TNF-α. Results: Totally, 27 patients were enrolled in this study. The types of pesticide ingested were glufosinate (n=6), glyphosate (n=8), organophosphate (n=4), pyrethroid (n=2), and others (n=7). The levels of inflammatory cytokines obtained were as follows: IFN-γ 2.78±8.03 pg/ml, IL-1β 2.62±2.03 pg/ml, IL-6 44.58±80.16 pg/ml, and TNF-α 11.80±15.60 pg/ml. The overall mortality rate was 11.1% (3/27), and levels of IL-1β and TNF-α were significantly higher in the death group compared to the survival group. Conclusion: Increased levels of IL-6 and TNF-α were observed in patients with acute pesticide poisoning. IL-1β and TNF-α were significantly higher in the death group as compared to the survival group. Our results indicate the occurrence of an inflammatory response due to the activation of immune cells by pesticide poisoning. Future large-scale studies need to be conducted to investigate the application of inflammatory cytokines as predictors and therapeutic targets.

Citations

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Insecticides and testicular health: mechanisms of injury and protective natural products
Samar F. Darwish, Yasser M. Moustafa, Sherif S. Abdel Mageed, Ghaneya S. Hassan, Safwat Abdelhady Mangoura, Shaza H. Aly, Mai A. Mansour, Ahmed Amr Raouf, Al-Aliaa M. Sallam, Sylvia F. Fawzi, Asmaa M. Atta, Ola Elazazy, Walaa A. El-Dakroury, Aya A. El-Dem
Naunyn-Schmiedeberg's Archives of Pharmacology.2025; 398(9): 11229. CrossRef
Assessment on Microplastic Contamination from Mulching and Non-Mulching Farmland in Selangor, Malaysia
Muhammad Zulfahim Zulkarnain, Siti Rohana Mohd Yatim, Nadiah Wan Rasdi, Nur Azalina Suzianti Feisal, Mitoriana Porusia
JURNAL KESEHATAN LINGKUNGAN .2025; 17(3): 245. CrossRef
Pesticide Exposure and Hypertension Risk in Indonesian Agricultural Workers: A Systematic Review and Meta-Analysis
Suratman, Khaidar Ali, Muhammad Addin Rizaldi
JURNAL KESEHATAN LINGKUNGAN .2025; 17(3): 230. CrossRef
Age Versus Immunity: Dietary Influences on Immunosenescence
Karolina Daniłowska, Natalia Picheta, Julia Piekarz, Dominika Żyła, Katarzyna Zych, Katarzyna Szklener, Sławomir Mańdziuk
Journal of Clinical Medicine.2025; 14(23): 8313. CrossRef

A case of various clinical aspects associated with cardiotoxicity after glufosinate poisoning: Seon Tae Kim; J Korean Soc Clin Toxicol. 2021;19(2):133-138. Published online December 31, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.2.133

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Abstract PDF: Glufosinate-containing herbicides is a non-selective herbicide commonly used worldwide. As the use of them increased gradually since paraquat was banned in 2012, the number of suicides by their ingestion is also increasing continuously. Complications of glufosinate-containing herbicide poisoning include various central nervous system (CNS) toxicities such as convulsions, loss of consciousness, memory impairment, and respiratory depression, which may be accompanied by hemodynamic changes such as bradycardia and hypotension. However, it is very rare that arrhythmias other than bradycardia occurred and Takotsubo cardiomyopathy was combined due to cardiotoxicity. A 71-year-old female patient was transferred to our hospital after ingesting 500 mL of glufosinate-containing herbicide and receiving 5 L of gastric lavage at a local hospital. A few hours later, she presented stuporous mentality, respiratory depression, and convulsions, and was accompanied by hypotension and bradycardia. On the second day of admission, electrocardiogram (ECG) showed bradycardia and QTc prolongation with hemodynamic Instability. Accordingly, we conducted the early treatment with continuous renal replacement therapy (CRRT) and the application of temporary cardiac pacemaker. An echocardiogram demonstrated decreased ejection fraction (EF) and Takotsubo cardiomyopathy on the third day of admission. Then, she was discharged safely with conservative treatment. At the follow-up after 1 year, Takotsubo cardiomyopathy, EF and QTc prolongation were recovered on echocardiogram and ECG. Because cardiac toxicity after glufosinate-containing herbicide poisoning may cause life-threatening consequences, caution is required while treating the patient. Therefore, if electrocardiogram changes are seen in the elderly with a large amount of glufosinate herbicide ingestion, additional cardiac function test through echocardiography should be concerned, and early treatment through CRRT or artificial cardiac pacing should be considered.

Initial Serum Ammonia as a Predictor of Mortality in Patients with Acute Glufosinate Ammonium Herbicide Poisoning: Eun Na Ko, Dong Hoon Kim, Soo Hoon Lee, Jin Hee Jeong, Sang Bong Lee, Aejin Sung, Ja Hyoen Suh, Changwoo Kang; J Korean Soc Clin Toxicol. 2020;18(2):136-140. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.136

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Purpose: The association of the initial serum ammonia level with in-hospital mortality in patients with acute glufosinate-ammonium herbicide poisoning was studied. Methods: This retrospective cohort study was conducted between March 2012 and August 2019 in the emergency department after glufosinate-ammonium herbicide poisoning. Survivors and non-survivors were analyzed using a Mann-Whitney U test and Fisher's exact test. Multivariate logistic regression analysis was performed to determine the independent risk factors for mortality. Results: One hundred and six patients were enrolled; 11 died, yielding a mortality of 10.4%. The serum bicarbonate level was significantly lower in the non-survival group than the survival group. Age, serum ammonia, blood urea nitrogen, creatinine levels, SOFA score, and APACHE II score were significantly higher in the non-survival group than the survival group. Age, serum ammonia, and creatinine level were independent risk factors for mortality in multivariate logistic regression analysis. Conclusion: The initial serum ammonia level is associated with mortality in patients with acute glufosinate herbicide poisoning.

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Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status
Rok Lee, Tae Yong Shin, Hyung Jun Moon, Hyun Jung Lee, Dongkil Jeong, Dongwook Lee, Sun In Hong, Hyun Joon Kim
Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 135. CrossRef

Risk Factors to Predict Acute Respiratory Failure in Patients with Acute Pesticide Poisoning: Nam-Jun Cho, Samel Park, Eun Young Lee, Hyo-Wook Gil; J Korean Soc Clin Toxicol. 2020;18(2):116-122. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.116

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Acute respiratory failure is an important risk factor for mortality in patients with acute pesticide poisoning. Therefore, it is necessary to investigate the risk factors to predict respiratory failure in these patients. This study retrospectively investigated the clinical features of respiratory failure among patients with acute pesticide poisoning requiring mechanical ventilation. This study included patients who were admitted with intentional poisoning by pesticide ingestion from January 2017 to December 2019. Paraquat intoxication was excluded. Among 469 patients with acute pesticide poisoning, 398 patients were enrolled in this study. The respiratory failure rate was 30.4%. The rate of respiratory failure according to the type of pesticide was carbamate (75.0%), organophosphate (52.6%), glufosinate (52.1%), glyphosate (23%), pyrethroid (8.9%), and others (17%). The mortality was 25.6% in the respiratory failure group. The risk factors for respiratory failure were old age, low body mass index, and ingestion of more than 300 mL. In conclusion, respiratory failure is a risk factor for mortality in pesticide poisoning. Old age, low body mass index, and ingestion of more than 300 mL are the risk factors for predicting respiratory failure.

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The 2022 Annual Report on Toxicology Surveillance and Severe Poisoning Cases at Emergency Departments in Korea
Eun Sun Lee, Su Jin Kim, Gyu Chong Cho, Mi Jin Lee, Byung Hak So, Kyung Su Kim, Juhyun Song, Sung Woo Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 1. CrossRef
Machine Learning-Based Prediction Models of Acute Respiratory Failure in Patients with Acute Pesticide Poisoning
Yeongmin Kim, Minsu Chae, Namjun Cho, Hyowook Gil, Hwamin Lee
Mathematics.2022; 10(24): 4633. CrossRef

Characteristics of Acute Herbicide Poisoning: Focused on Chlorophenoxy Herbicide: Hakyoon Song, Sangchun Choi, Yoon Seok Jung, Eunjung Park, Hyukhoon Kim; J Korean Soc Clin Toxicol. 2019;17(2):126-131. Published online December 31, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.2.126

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Purpose: Herbicide-related mortality has decreased since the complete ban of paraquat product sales in 2012, but there still have been other herbicides intoxications with relatively severe complications. Glyphosate and glufosinate herbicides are used widely, and considerable research has been conducted. Chlorophenoxy herbicide is another major herbicide that has shown poor outcomes and mortality without proper management, but research in this area is lacking. Therefore, this study compared the clinical features of chlorophenoxy herbicide with those of other herbicides. Methods: The medical records of patients exposed to herbicides at a tertiary academic university hospital in Korea from May 2014 to April 2019 were reviewed retrospectively. The demographic and clinical data of 135 patients were then analyzed to identify the recent herbicides intoxication trends after the paraquat sales ban, focusing mainly on chlorophenoxy herbicide poisoning. Results: Of the 135 patients, 13 patients (9.6%) had chlorophenoxy herbicide poisoning. No significant differences in all the variables were observed between the chlorophenoxy herbicide poisoning group and non-chlorophenoxy herbicides poisoning groups. Toxic symptoms after poisoning varied from nothing noticeable to confusion; none of the patients had severe complications after their treatments. Conclusion: Acute chlorophenoxy poisoning is relatively less severe, with lower mortality rates than glyphosate and glufosinate poisoning.

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Association between continuous renal replacement therapy and mortality after acute herbicide (glyphosate and/or glufosinate) intoxication: propensity score matching approach
Seung Woo Lee, Won-joon Jeong, Seung Ryu, Yongchul Cho, Yeonho You, Jung Soo Park, Changshin Kang, Hong Joon Ahn, So Young Jeon, Jinwoong Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 17. CrossRef

A Study of Predicting the Severity Following Glufosinate Ammonium Containing Herbicide Poisoning Experienced in Single Emergency Medical Institution: Doo Sung Lee, Kyoung Ho Choi; J Korean Soc Clin Toxicol. 2019;17(1):7-13. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.7

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Abstract PDF: Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.

Comparison of Clinical Characteristics and Severity of Glyphosate and Glufosinate Herbicide Poisoning Patients: Hyung Sun Joo, Tae Ho Yoo, Soo Hyung Cho; J Korean Soc Clin Toxicol. 2018;16(2):124-130. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.124

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Abstract PDF: Purpose: The number of glyphosate and glufosinate intoxication cases are increasing in Korea. This study was undertaken is to compare the clinical manifestations of poisoning by these two herbicides and to document severities and clinical outcomes. Methods: We retrospectively evaluated cases of glyphosate or glufosinate intoxication among patients that visited our emergency department between January 1, 2013, and December 31, 2017. Incidences of intoxications were analyzed over this five year period, and underlying diseases, transportation, mental state, shock occurrence, inotropics, gastric lavage, charcoal administration, intubation and ventilator therapy, and hemodialysis were investigated. In addition, we included transfer to the intensive care unit, incidences of pneumonia and of other complications, death, and hopeless discharge. Results: There were 119 cases of glyphosate intoxication and 42 of glufosinate intoxication. Levels of consciousness were lower for glufosinate and vasopressor usage was higher due to a high shock rate (p=0.019). In addition, many patients were referred to the ICU for intubation and ventilation. The incidences of pneumonia and of other complications were significantly higher for glufosinate. Conclusion: Overall glufosinate intoxication was found to be more severe than glyphosate intoxication as determined by complication and ICU admission rates.

Relationship between Serum Neuron Specific Enolase Level and Seizure in Patients with Acute Glufosinate Ammonium Poisoning: Gyo Jin An, Yoonsuk Lee, Yong Sung Chan, Hyun Kim; J Korean Soc Clin Toxicol. 2018;16(1):49-56. Published online June 30, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.1.49

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Abstract PDF: Purpose: Glufosinate ammonium poisoning can cause seizures, even after a symptom-free period. This study was conducted to evaluate the relationship between serum neuron specific enolase (NSE) level and the occurrence of seizures in patients with acute glufosinate ammonium poisoning. Methods: For this retrospective observational study, data from patients diagnosed with acute glufosinate ammonium poisoning were collected between January 2016 and June 2016. Serum NSE was measured within 2 hours of arrival at the emergency department. The patients were divided into a seizure group and a non-seizure group. Results: The seizure group included eight of the 15 total patients (53.3%). The serum NSE level was significantly higher in the seizure group than in the non-seizure group ($32.4{pm}11.9ng/mL$ vs. $19.5{pm}5ng/mL$, p=0.019). The amount of glufosinate ingested and initial and peak serum ammonia levels were significantly higher in the seizure group than in the non-seizure group. There was no significant difference in the area under the curve of the serum NSE level or the initial and peak serum ammonia levels in terms of predicting the occurrence of seizures. Conclusion: In acute glufosinate poisoning, initial serum NSE levels may help in prediction of seizures.

The Usefulness of Serum Lipid Concentration as a Predictor of Convulsion in Patients with Glufosinate Ammonium Poisoning: Hyun Do Lee, Kyung Hoon Sun, Seong Jung Kim; J Korean Soc Clin Toxicol. 2017;15(1):40-46. Published online June 30, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.1.40

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Abstract PDF: Purpose: Glufosinate ammonium (GA; phosphinothricin) can induce neurological complications such as altered mental status, amnesia, and convulsions. This study was conducted to evaluate whether blood lipid profiles can help predict convulsions in patients with GA poisoning. Methods: This study was a retrospective review of data acquired at a tertiary academic university hospital from March 2014 to July 2016. Independent t-test, Mann-Whitney test and Analysis of covariance (ANCOVA) of demographic and laboratory findings of 50 patients with GA poisoning were performed to identify correlations of general characteristics and laboratory findings, including blood lipid profiles of GA-poisoned patients between with and without convulsions. Results: Convulsion as a GA complication showed a significant association with poison volume, age, white blood cell count, and creatine phosphokinase (CK), albumin, lactate dehydrogenase (LDH), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) content in blood according to an independent t-test and Mann-Whitney test. However, ANCOVA demonstrated significant association with LDL and triglyceride. Conclusion: Blood lipid profiles, especially serum LDL and triglyceride, were useful in predicting convulsions in patients with GA poisoning.

Utility of the APACHE II Score as a Neurologic Prognostic Factor for Glufosinate Intoxicated Patients: Dae Han Yoo, Jung Won Lee, Jae Hyung Choi, Dong Kil Jeong, Dong Wook Lee, Young Joo Lee, Young Shin Cho, Joon Bum Park, Hae Jin Chung, Hyung Jun Moon; J Korean Soc Clin Toxicol. 2016;14(2):107-114. Published online December 31, 2016; DOI: https://doi.org/10.22537/jksct.2016.14.2.107

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Purpose: The incidence of glufosinate poisoning is gradually increasing, and it can be fatal if severe poisoning occurs. However, factors useful for predicting the post-discharge neurological prognosis of patients who have ingested glufosinate have yet to be identified. Our objective was to evaluate the utility of the acute physiology and chronic health evaluation (APACHE) II score measured in the emergency department for predicting the neurological prognosis. Methods: From April 2012 to August 2014, we conducted a retrospective study of patients who had ingested glufosinate. The outcome of the patients at discharge was defined by the Cerebral Performance Category Score (CPC). The patients were divided into a good prognosis group (CPC 1, 2) and a poor prognosis group (CPC 3, 4, 5), after which the APACHE II scores were compared. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve from patients determined calibration and discrimination. Results: A total of 76 patients were enrolled (good prognosis group: 67 vs poor prognosis group: 9). The cut-off value for the APACHE II score was 12 and the area under the curve value was 0.891. The Hosmer and Lemeshow C statistic x2 was 7.414 (p=0.387), indicating good calibration for APACHE II. Conclusion: The APACHE II score is useful at predicting the neurological prognosis of patients who have ingested glufosinate.

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Association between continuous renal replacement therapy and mortality after acute herbicide (glyphosate and/or glufosinate) intoxication: propensity score matching approach
Seung Woo Lee, Won-joon Jeong, Seung Ryu, Yongchul Cho, Yeonho You, Jung Soo Park, Changshin Kang, Hong Joon Ahn, So Young Jeon, Jinwoong Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 17. CrossRef
Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status
Rok Lee, Tae Yong Shin, Hyung Jun Moon, Hyun Jung Lee, Dongkil Jeong, Dongwook Lee, Sun In Hong, Hyun Joon Kim
Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 135. CrossRef

Epidemiology and Clinical Analysis of Poisoning of Glufosinate Herbicide - Multicenter Study -: Sung-Woo Lee, Yun-Sik Hong, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Joo-Hyun Suh, Hyung-Keun Roh; J Korean Soc Clin Toxicol. 2007;5(1):36-42. Published online June 30, 2007

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Abstract PDF: Purpose: To assess the epidemiology and the clinical features of Glufosinate herbicide in Korea. Methods: Data was prospectively collected during 1 year since August 2005 from 38 hospital in Korea. We analyzed the epidemiologic characters and clinical manifestations of Glufosinate poisoning. In addition, the characteristics of patients with severe central nervous system toxicity were separately analyzed to find poor prognosis relating factors. Results: During study periods, there were 715 persons of poisoning of herbicides and insecticides. 6.3% (45 persons) of the agricultural chemicals poisoning had Glufosinate poisoning. There were 36 cases of suicide attempts and 7 cases of accidental exposure, The major of poisoning route was oral ingestion (44 cases). 28.9 % of the study patients had not toxic symptoms. The most common symptoms were gastrointestinal symptoms relating surfactant irritation. 67.7% of central nervous symptoms occurred lately. 10 persons showed severe central nervous system toxicity. 4 persons of them showed poor outcomes (1 death, 3 hopeless discharged). Complications of respiratory failure and renal failure related with poor outcome. Conclusion: Majority of patients ingested Glufosinate for suicide attempt. 22.2% of patients with Glufosinate poisoning showed delayed serious central nervous system toxicity. Early supportive care of altered mentality may prevent late respiratory complications and improve the outcomes.

A Case of anterograde amnesia with hippocampal lesions following glufosinate intoxication: Seung-Hwan Seol, Hyeon-Soo Park, Jung-Hwan Ahn, Hee-Young Park, Phil-Hyu Lee, Gi-Woon Kim; J Korean Soc Clin Toxicol. 2006;4(1):61-64. Published online June 30, 2006

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Abstract PDF: Glufosinate ammonium (GLA), a phosphinic acid derivate of glutamate, is a broad-spectrum contact herbicide. It structurally resembles glutamate, a typical excitatory amino acid in the central nervous system. In korea, the ingestion of GLA for suicidal attempt or accidental event has increased. The neurological complication of GLA intoxication are characterized by loss of consciousness, convulsion, or memory impairment. But, the exact mechanism of GLA toxicity is yet unknown. This report is about a patient with GLA intoxication who showed anterograde amnesia with selective bilateral hip-pocampal lesions supported GLA intoxication with literature reviews supported.

A Case of Acute Glufosinate Ammonium ($BASTA^{(R)}$) Intoxication Associated with Various Neurological Abnormalities: Jin Hui Paik, Jun Sig Kim, Hyeon Gyu Yi, Hyun Joo Park, Choong-Kun Ha, Hyung-Keun Roh; J Korean Soc Clin Toxicol. 2005;3(2):103-106. Published online December 31, 2005

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Abstract PDF: BASTA is an herbicide which contains glufosinate ammonium as a main component with an anionic surfactant, polyoxyethylene alkylether sulfate, and nonselectively inhibits glutamine synthetase. It became a wildly used herbicide in Korea and its intoxication is now increasing. A 42-year old woman ingested about 300ml of BASTA in a suicide attempt. She showed unconsciousness and respiratory distress in the beginning, and later developed multiple generalized convulsions, low blood pressure, fever and diabetes insipidus. Although she became alert 12 days after the ingestion, she showed retrograde amnesia for a period of about recent 10 years. A neuropsychological test on day 22 revealed frontal lobe dysfunction, visual memory disturbance and slight decrease in visuospatial function. All these neurological abnormalities that might occur due to glufosinate ammonium were almost improved in the follow-up test performed a month later.

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