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논문분류	춘계학술대회 초록집
제목	Renal effects of intentional self-poisoning with Chlorophenoxy herbicide [2-Methyl-4-chlorophenoxyacetic acid (MCPA)] – A case report
저자	Thilini Wijerathna1, Dhammika Dissanayaka2, Anuradha Colombage3, Indika Gawarammana4
출판정보	2018; 2018(1):
키워드	MCPA \| Renal effects \| Oxidative phosphorylation
초록	Case Study: Nephrotoxicity due to pesticide self poisoning is common in developing countries. Poisoning with Chlorophenoxy herbicide [2-Methyl-4-chlorophenoxyacetic acid (MCPA)] has been associated with acute kidney injury and high case fatality of up to 11%. We report a patient with renal effects of MCPA. A 40-year-old man was transferred to teaching hospital Peradeniya, Sri Lanka 2 hours after MCPA ingestion. On day 2 he had serum creatinine level of 1.56 mg/dl that increased till day 3 and gradually decreased to 1.05 on day 8. Increased serum creatine kinase was seen on day 2 (3835 U/L) and peaked on day 3 (11480), gradually decreased to 1506 U/L by day 8. Serum Ca2+ level was <0.1 mmol/l on day 2 and remained below the normal range till day 5. Low serum K+ level was noted from day 2 (3.52 mmol/l) and lowest level of 2.1 was seen on day 3 despite KCl replacement. After day 5, serum K+ gradually improved. Mild elevation of serum magnesium was noted on day 5. Serum lactate level was high from day 1 and remained above the normal range till day 4. Patient showed low serum HCO3- persistently till day 5 even with intravenous bicarbonate treatment. Blood pH remained normal throughout, however, urine pH was acidic from day 1 (5.5) and became normal on day 8. His urine volume and colour remained normal. In addition to the renal effects he showed evidence of gastrointestinal, pulmonary, cardiac, central nervous system and metabolic effects. Patient required mechanical ventilation and made a complete recovery. Renal effects of intentional self-poisoning with MCPA can be due to Rhabdomyolysis or renal tubular injury as the uncoupling of oxidative phosphorylation that leads to decreased mitochondrial respiration and ATP depletion. As laboratory assays on tubular biomarkers were not available in our hospital, tubular damage was not confirmed.
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