Efecto tóxico por herbicida metahemoglobinizante en cuidado crítico: intoxicación por propanil, un reporte de caso

Abstract

Propanil poisoning, a methemoglobinemia-inducing herbicide pesticide, causes a wide range of signs and symptoms, from mild manifestations such as fatigue to severe complications including cyanosis, arrhythmias, neurological deficits, ventilatory failure, and even death, depending on the degree of exposure to the toxin. In low- to medium-complexity healthcare institutions that lack the ability to identify the toxin or quantify the degree of intoxication, diagnosing and managing such cases presents a significant challenge. The lethal dose of propanil exposure is approximately 10 ml of the undiluted compound or 200 ml in its diluted form. Therefore, clinical manifestations and score NEWS2 become a crucial tool in guiding diagnosis and treatment, improving morbidity and mortality rates. Various experimental treatments exist, but there is insufficient scientific evidence to effectively manage this type of poisoning and prevent acute outcomes such as hepatopathy or fatal complications like haemolysis. However, methylene blue has emerged as the antidote of choice for moderate to severe methemoglobinemia. Few patients require exchange transfusion to mitigate the high risk of mortality. Public health policies have demonstrated a reduction in the incidence of morbidity and mortality associated with propanil poisoning.