By Teder D. Depaynos, MD

The 27 year old male patient was brought to the Emergency Room (ER) nearly midnight when his relatives noticed him to be severely vomiting. Initially, they thought that it was just the food and drinks that he took because he came from a neighboring happening but when they noticed that his vomitus was “smelly” and apparently food is no longer in his vomitus , they became curious and worried. When one of the relatives mentioned that the vomitus smells like the “chemical” they spray in their garden to control the growth of weeds, they all went to the tool room where they kept their garden supplies and utensils. To their surprise, the “herbicide” can was nearly empty! Meanwhile the retching of the patient was becoming more severe and he appeared to be getting weaker.
They confronted the patient showing the nearly empty can until finally he admitted what he drank. Despite his objection, he finally was brought to the hospital.
The initial treatment of course was to drain the stomach hoping that the “chemical” or what was left yet despite his severe vomiting could still be removed preventing their systemic absorption. Ideally, a tube inserted thru the nose going to the stomach or naso-gastric tube (NGT) should be placed and thru this the stomach could be flushed with sterile water. Although the patient agreed to be rushed to the hospital he was not cooperative despite the pleadings of his relatives. He refused the NGT and the IV fluid that is supposed to be inserted. The ER MDs even suggested that he should be sedated so they could proceed with their emergency measures. Finally, the patient demanded to sign a waiver witnessed by his relatives so that he could go home.
The MDs were very much worried and warned the relatives of unfavorable outcome. They had similar cases from time to time in the past where some of the patients succeeded in ending their life despite their aggressive resuscitations. He could always be returned of course and they hoped that it would not be too late. They also advised them to research why he did what he did!
Obviously, it was not accidental that the patient drank the “Herbecide”. If he survives the incident a psychiatrist may be required. His problems may be dissected and advices how to overcome them would be suggested. Monitoring his actions would also be important.
Ideally, the components of what was taken should be known so somehow their effects to the human body could be predicted. Obviously, if it was an acid, vomiting is contraindicated. The MDs were not familiar with the “Herbicide” but since it is used to destroy grasses it must also be poisonous.
In general, when cases like these are brought to the ER, the “basic and advanced cardiac life support” is implemented. The patient’s airway and the degree of ventilation must be adequate. And likewise the circulatory status determined and maintained within normal. Vital signs are measured frequently together with the body core temperature.”
The level of consciousness is assessed and if unconscious aggressive management is done.
Although the patient appeared dehydrated and weak probably due to his severe vomiting, he was still very conscious and his vital signs were within normal. The MDs surmised that he probably vomited most of what he drank or what he drank was much diluted or it was only very minimal. In the first probability, he was very lucky. In the last probability, he must just be attracting attention.
Aside from inducing emesis and doing gastric lavage to clear the stomach, the use of Activated Charcoal (AC) is sometimes done hoping that the chemicals will be adsorbed and eventually will be passed out with the stools.
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