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Chlorophenoxy Herbicides

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Critical Care Toxicology

Abstract

Chlorophenoxy herbicides (phenoxycarboxylic acid herbicides) are weed killers that act as synthetic auxins (plant “hormones”) and cause plant death by disrupting nutrient transport and growth. Most cases of serious poisoning involve deliberate ingestion. The pathophysiology of toxic effects involves dose-dependent call membrane damage, uncoupling of oxidative phosphorylation and impaired acetyl-coA metabolism. Vomiting is a prominent early feature. Gastrointestinal fluid loss, vasodilation, and direct myocardial toxicity contribute to hypotension, which may precipitate renal failure. Rapid onset of coma is common in severe cases. The incidence of other neurological features varies widely. Hypoventilation secondary to central nervous system depression is the primary cause of hypoxia, although respiratory muscle weakness also may occur as part of a generalized myopathy. Fasciculation and/or myotonia may also be present. Neuromuscular effects may persist for several weeks. The prognosis is poor in patients who rapidly become shocked and comatose but full recovery can ensue over weeks to months despite initial severe toxicity. Most patients can be managed with symptomatic and supportive care alone. There is level III evidence for enhancing chlorophenoxy herbicide elimination by either urine alkalinization or hemodialysis.

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Author information

Authors and Affiliations

  1. National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham, UK

    Sally M. Bradberry & J. Allister Vale

  2. School of Biosciences, University of Birmingham, Birmingham, UK

    Sally M. Bradberry & J. Allister Vale

Authors
  1. Sally M. Bradberry
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  2. J. Allister Vale
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Corresponding author

Correspondence to Sally M. Bradberry .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, Second Edition

  • I Evidence obtained from at least one properly randomized controlled trial.

  • II-1 Evidence obtained from well-designed controlled trials without randomization.

  • II-2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  • II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  • III Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Bradberry, S.M., Vale, J.A. (2017). Chlorophenoxy Herbicides. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_6

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