Acute Tribenuron-methyl Herbicides Poisoning in Human: A Case Report from A Resource-limited Setting

Tribenuron-methyl is a water soluble, colorless, non-corrosive herbicides – sulphonylureas, which inhibits acetolactate synthase an enzyme involved in branched-chain amino acid biosynthesis. It has sulphonylureas antidiabetic effects and/or the volatile oily or hydrocarbons solvent which is easily inhaled and which have potential systemic toxicity and cause respiratory distress. Evidence related to human exposure remain limited. We report a case of 30 yrs. old female patient who presented after 6 h of taking Tribune 75% WDG (Tribenuron-methyl) 2 gram of single Sacket, after she mixed it with 1 Arabic coffee cup of water after she had a quarrel with a family member. Upon presentation her blood pressure was unrecordable, heart rate = 136, feeble, respiratory rate = 48, deep labored with accessary muscle use, temperature of 35 °c, oxygen saturation = 60%, her oral cavity was full of secretion, her chest finding was diffuse bilateral crepitation’s. S1 and S2 were well heard, no abdominal finding her mental status was Glasgow coma scale of 13. Pinpoint pupil and no motor preference her random blood sugar was 154 mg/dl. She was managed with crystalloids, oxygen with non-rebreather facemask and started on norepinephrine. After 6 h. of stay, all her deranged vital sign were corrected and she was discharged on her 4th day with link to psychiatry follow-up clinic. Tribenuron-methyl herbicide- sulphonylureas poisoning is rare and often the full clinical features are unknown in human. The main presenting features hypoglycemia often due to it antidiabetics property and respiratory distress from its oily hydrocarbon’s solvent. The main stay of management is supportive care with oxygenation, ventilation and hypoglycemia treatment. If the patients presented early with in one hours and airway protected, gastric lavage and single dose activated charcoal can be given.