P128 Acute buctryl poisononig- a rare and severe entity

Backround and aims . Buctril (bromoxynil octanoate) is a contact nitrile herbicide used against annual broadleaf weeds. The aim of this study is to present a severe and rare case of bromoxynil poisoning Methods We present the case of a 16 years old girl who was admitted in our department eight hours after ingestion of an unspecified amount of herbicide – Buctril. Results An hour after ingestion the patient presented asthenia, breathing difficulties, profuse sweating, thirst and abdominal pain. Her family requested the ambulance that transported her to the local hospital where she presented:dyspnea (respiratory rate 44/minute) tachycardia (heart rate:130/minute), intractable vomiting. Gastric lavage, iv Ranitidine and Ringer’s solution were performed,then sent the patient to our hospital At the presentation,eight hours after ingestion, she was: conscious, oriented, pale, diaphoretic with a temperature 36.6 degrees Celsius, pulse rate of 164/minute, blood pressure of 127/62 mmHg, respiratory rate of 40 per minute, vomiting, abdominal pain. She was admitted to the Toxicology Department and received endovenous treatment with glucose and electrolytes, vital functions beeing continuously monitored. Blood tests taken revealed normal values for: white blood cells, platelets,haemoglobin, glucose, serum electolytes, plasma cholinesterase, creatinphosphokinase, normal renal and liver function tests. One hour after admission the patient presented progressive impairment of consciousness, hyperthermia (41°C)and hypotension (BP=85/54 mmHg). She was immediately transported to the intensive care unit and one hour later she became unconscious ; dyspnea (RR=48/min) and tachycardia (HR>200 bpm) were aggravated. She was intubated and mechanical ventilated.In evolution in few hours, bradycardia then asystole and cardiac arrest were installed despite cardiopulmonary resuscitation.. Conclusions The toxicity of bromoxynil, particularly in acute self-poisoning, has not been well studied and defined. This case highlights the unpredictable and fulminant clinical course of herbicide poisonings