Urinary alkalinisation for acute chlorophenoxy herbicide poisoning

  • Review
  • Intervention

Authors

  • Darren M Roberts,

    Corresponding author
    1. Medical School, Australian National University, South Asian Clinical Toxicology Research Collaboration, Canberra, Australian Capital Territory, Australia
    • Darren M Roberts, South Asian Clinical Toxicology Research Collaboration, Medical School, Australian National University, Canberra, Australian Capital Territory, 0200, Australia. 1darren1@gmail.com. 1darren1@gmail.com.

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  • Nick Buckley

    1. University of NSW, Professorial Medicine Unit, POWH Clinical School, Randwick, NSW, Australia
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Abstract

Background

Acute poisoning with chlorophenoxy herbicides (such as 2,4-D, MCPA, 2,4,5-T and mecoprop) is reported worldwide, potentially causing severe toxicity and death in exposed patients. Animal studies support the application of urinary alkalinisation (particularly using sodium bicarbonate) in the management of acute chlorophenoxy herbicide poisoning to facilitate excretion of these herbicides. Some case reports of human exposure have suggested benefit from urinary alkalinisation also.

Objectives

To assess the efficacy of urinary alkalinisation, in particular sodium bicarbonate, for the treatment of acute chlorophenoxy herbicide poisoning.

Search methods

We searched MEDLINE, EMBASE, CENTRAL, Current Awareness in Clinical Toxicology, Info Trac, http://www.google.com.au, and Science Citation Index of studies identified by the previous searches. The bibliographies of identified articles were reviewed and experts in the field were contacted.

Selection criteria

Randomised controlled trials of urinary alkalinisation in patients ingesting a chlorophenoxy herbicide and presenting within 24 to 48 hours of poisoning were sought. The quality of studies and eligibility for inclusion was assessed using criteria by Jadad and Schulz.

Data collection and analysis

Authors independently extracted data from the identified studies using a pre-designed form. Study design, including the method of randomisation, participant characteristics, type of intervention and outcomes were all recorded.

Main results

No studies were identified which satisfied inclusion criteria.

Authors' conclusions

There is insufficient evidence to support the routine use of urinary alkalinisation for acute chlorophenoxy herbicide poisoning. A well conducted randomised controlled trial is urgently required to determine whether the efficacy and indications of this treatment.

摘要

背景

鹼化尿液治療急性氯苯氧基除草劑中毒

氯苯氧基(chlorophenoxy)除草劑(如2,4D, MCPA, 2,4,5T和mecoprop)急性中毒曾經全球報導,可能造成患者嚴重毒性與死亡。動物實驗支持以鹼化尿液(特別是碳酸鈉)加速除草劑排除體外,來治療氯苯氧基除草劑中毒,一些人類的案例報告亦指出鹼化尿液的好處。

目標

評估鹼化尿液治療急性氯苯氧基除草劑中毒的效果,尤其是碳酸鈉。

搜尋策略

確認所檢索MEDLINE, EMBASE, CENTRAL, Current Awareness in Clinical Toxicology, Google及科學研究書目索引,經過審閱及與該領域專家諮詢,確認的參考文獻書目。

選擇標準

攝入急性氯苯氧基除草劑,24至48小時內中毒患者經鹼化尿液的隨機控制試驗被檢視,以嘉德(Jadad)及舒爾?(Schulz)標準評定研究品質及資格相符著。

資料收集與分析

作者運用先前已設計好的表單,由已經確認的研究獨立地選取數據;紀錄隨機分配的方法、參與者的特性、介入的型態及果效。

主要結論

沒有研究符合納入條件。

作者結論

尚無足夠的證據支持常規使用鹼化尿液治療急性氯苯氧基除草劑中毒。導入好的隨機控制試驗迫切需要,以確認治療的療效。

翻譯人

本摘要由高雄榮民總醫院毛志民翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

支持以鹼化尿液治療急性的氯苯氧基除草劑中毒數據有限。氯苯氧基除草劑(如2,4D, MCPA)急性中毒曾經全球報導,可能造成患者嚴重毒性與死亡。因為沒有解毒劑,鹼化尿液可加速除草劑排除體外;雖然,第一個鹼化尿液的臨床試驗早於30年前完成,至今卻仍未納入常規使用,治療急性的氯苯氧基除草劑中毒患者。這篇回顧尋找這類治療中毒病患的研究,但確定沒有足夠的品質的研究;因此,不建議常規使用。不過,由於目前嚴重中毒患者的治療結果不佳,或許加入標準加護療程有其角色。更多的研究應該進行。

Plain language summary

Limited data supports use of urinary alkalinisation for the treatment of acute chlorophenoxy herbicide poisoning.

Acute poisoning with chlorophenoxy herbicides such as 2,4-D and MCPA is reported world wide, potentially causing severe toxicity and death. Since there is no antidote for chlorophenoxy herbicides, treatments such as urinary alkalinisation have been used to increase the clearance of these poisons from the body. Although urinary alkalinisation was first trialled over 30 years ago, it is not currently used routinely for the treatment of patients with acute chlorophenoxy poisoning. This review looked for studies where this treatment had been given to poisoned patients. No studies of sufficient quality were identified and therefore routine use of this approach to treatment cannot be recommended. However, due to the poor outcomes in patients who present with severe toxicity it may have a role in addition to standard intensive care support. More research should be conducted.