SHM Converge Scientific Abstract ePoster Gallery-Navigating the Complexities of Diquat Poisoning: A Case of Intramuscular Injection

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This case report describes a rare and unusual presentation of diquat poisoning following an attempted suicide by intramuscular injection of 7.5 mL of herbicide containing diquat dibromide in a 26-year-old transgender male with depression. Unlike the more common oral ingestion cases, this route bypassed the gastrointestinal tract but still caused systemic toxicity.<br /><br />On arrival to the emergency department, the patient had diaphoresis, palpitations, nausea, vomiting, and agitation, though he was initially alert and neurologically intact. Early management included poison control consultation, supportive care with IV fluids and antiemetics, and monitoring. He later developed worsening bradycardia, increasing agitation, and neurological decline, followed by hypertension, tachycardia, and fever. Laboratory testing showed marked leukocytosis, rising creatinine, elevated liver enzymes, and increased lactate, consistent with inflammatory response and evolving multi-organ dysfunction.<br /><br />The report emphasizes that diquat is a highly toxic herbicide that generates free radicals and can cause severe cellular injury, often affecting the kidneys, lungs, liver, heart, and nervous system. Although poisoning is rare, it is frequently fatal. This case is notable because intramuscular injection produced both expected toxic effects and atypical clinical challenges, highlighting gaps in current understanding of non-oral exposure.<br /><br />Management proved difficult, with eventual ICU transfer, administration of N-acetylcysteine and dexamethasone, and intubation due to worsening mental status. The authors note that delayed intensive care and the unclear benefit of dialysis or hemoperfusion may have affected outcomes. Overall, the case underscores the need for rapid recognition, aggressive supportive care, and further study of unusual routes of diquat poisoning.

Asset Subtitle

Waleed Ikram

Meta Tag

Author List Amy Anderson, Dinuka Dandara, Mateen Khokhar, Waleed Ikram

Category Clinical Vignettes

Concept Diquat Dibromide

Concept Diquat Poisoning

Concept Free Radical Formation

Concept Organ Failure

Concept Route of Exposure

Distinguished Non-Finalist

Presenter Organization Creighton University - Phoenix

Presenting Author Waleed Ikram

Track Adult

Keywords

diquat poisoning

herbicide toxicity

intramuscular injection

suicide attempt

systemic toxicity

multi-organ dysfunction

free radical injury

emergency department

intensive care unit

N-acetylcysteine

Diquat Dibromide

Diquat Poisoning

Free Radical Formation

Organ Failure

Route of Exposure