Gramoxone Poisoning

The more severe patients who come in with Gramoxone poisoning are immediately monitored. This poison has made its way to the top of the deadliest toxins out there, which is available commercially.

It is a weedicide used to protect the main produce and hence almost always present in every Indian farmer’s home. The outcome of taking this compound is dire as it affects multiple organs at the same time and leads to a painful death.

Mechanism of action of gramoxone

Gramoxone-induced toxicity is a manifestation of its ability to undergo redox potential and catalyse the formation of highly reactive oxygen and nitrite species. This results in toxicity in most organs, but the toxicity is particularly severe in the lungs as it is taken up against a concentration gradient into the lungs.

Medical management of Gramoxone poisoning (as followed by Kolhapur Government Medical College)

1. Usually, the ingestion of such a poison is clean and hardly ever contaminates clothes or the skin of the patient. So, if any external exposure is noticed, the body must be thoroughly cleansed, and garments must be removed.
2. An IV line must immediately be secured with a wide-bore needle usually of 22- and 20-sized gauge (blue and pink respectively).
3. A ‘Ryle’s tube’ should be inserted for easy parenteral access specifically for washing and lavage (in this scenario).
4. Next, a solution containing Fullers Earth (Multani Mithi) mixed with plain water/normal saline should be prepared. The only indication for this modality is whether the poison was consumed within 2-4 hours of bringing the patient to the emergency department. Fullers Earth is a common household powder used massively by Indian women for cosmetic purposes. It is the use of such unconventional methods and a narrow time frame which make such cases worth discussing and exploring. Very little has been studied about Fullers Earth being utilised for medical emergencies and thus, the mechanism of action by which it wins life over is still unclear. The solution prepared in a tub should immediately be pushed via two maneuvers:
   1. Manually pushing repeated amounts of 50 ml of the mixture till 500-1000 ml in total is achieved.
   2. Mixing the compound in a 500 ml bottle of normal saline and directly giving a wash through the “Ryle’s tube” leads to quicker results. In this case, the patient might start vomiting because of certain uncalled reflexes but the wash must still go on until the desired amount of Fullers Earth and water is not achieved.
5. After this tedious process, there should be a waiting period of around 15 minutes to allow the poison to get completely absorbed into the mixture.
6. The process of gastric lavage must be initiated when any such external agent is used for a bowel wash, but as the mixture is coarse, using a suctioning machine is futile. Therefore, a 20- or 50-ml syringe is used, and the stomach content is pulled out via the “Ryle’s Tube”.
7. The stomach contents should be collected and the suctioning should continue until a clear fluid is obtained in the container or the entire bowel is empty, whichever is achieved first. After the patient stabilises, he should be prepared for 'Haemodialysis' to prevent acute renal failure. 
8. Throughout this process, a continuous access of IV normal saline infusion should be administered to maintain the volume loss and to compensate for the patient's inability to swallow.

Note: Various organ pathologies which are simultaneously going on have not been discussed as they are out of the context with this text.

Depending on the hospital one gets treated in, there are many interventional modalities for managing gramoxone poisoning all over the country, but the above-mentioned text proves to be the bare minimum followed by most hospitals in the interiors of the state.