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• W1978912828 abstract "IntroductionMonosodium methylarsonate (MSMA) is a selective pre-emergent contact herbicide considered to be significantlyless toxic than inorganic arsenic. Animal studies extrapo-lated to humans have estimated a low order of toxicity [1],but little information is available regarding overdose inhumans. Previous reports have described oral exposureswith less concentrated formulations of MSMA herbicides[2] or via dermal absorption [3]. Because of the limitedinformation in the current literature, concern exists regard-ing exposures to concentrated forms of organic arsenic. Wedescribe exposures to a common crabgrass killer containing47% MSMA.Index CasesCase 1 A 16-year-old female with a past medical history ofdepression (not on any medications) presented afterintentional ingestion of crabgrass killer. The patient hadan argument with her grandmother and locked herself in thegarage where she drank up to 240 cc of Bonide® crabgrasskiller that contained 47% MSMA. She vomited and wastaken to the emergency department (ED) approximately 1 hafter the exposure. In the ED, the patient was agitated. Shecomplained of abdominal pain and generalized weakness.Her vital signs were: blood pressure 134/78 mmHg, heartrate 126 beats per minute, respirations 16 breaths perminute, and oxygen saturation 100% on room air. Shereceived a bolus of 3 l of normal saline (NS) and was thenstarted on NS at 500 ml/h. The patient was endotracheallyintubated for gastric lavage and for transportation to thelocal children's hospital. Gastric lavage was done at thediscretion of the treating physician, and no material wasretrieved. On arrival to the children's hospital, her vitalsigns and physical exam were normal; she was able tofollow commands. Electrolytes and complete blood count(CBC) were unremarkable. A single dose of 192 mg ofBritish anti-Lewisite (BAL) IM was administered approx-imately 12 h after the ingestion; extubation occurred severalhours after arrival. Urine was collected in a Foley catheterfor a 24-h heavy metal measurement. Dimercaptosuccinicacid (DMSA) was then initiated at 500 mg every 8 h bymouth for 5 days followed by 500 mg every 12 h for14 days.In the hospital, the patient complained of generalizedabdominal pain, weakness, and parasthesias. She did nothave any more vomiting and never had diarrhea; mildhyperreflexia was noted on exam. She was able to eat afterbeing extubated, and paresthesias and abdominal painimproved during her hospitalization. Initially, she haddifficulty walking, but by day 5, she was walking withoutassistance and was discharged to a psychiatric institution.There, she was continued on DMSA for the remainder ofher 19 days of treatment. After discharge, the results of herheavy metal screen returned and are noted in Table 1.Six weeks later, the patient was followed up in thetoxicology clinic where she complained of mild paresthe-sias in her hands and feet that developed after beingtransferred to the psychiatric hospital. The episodes lastedfor minutes at a time, occurred in the morning, and never" @default.
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• W1978912828 date "2011-02-12" @default.
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• W1978912828 title "Good Outcomes Despite High Urinary Arsenic Concentrations from Overdose with Crabgrass Killer" @default.
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• W1978912828 doi "https://doi.org/10.1007/s13181-011-0138-6" @default.
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