Refractory ventricular dysrhythmia following a large intentional glyphosate overdose: a case report

Introduction Glyphosate is a widely used herbicide that can cause severe multiorgan dysfunction in overdose. Ventricular dysrhythmia is rarely reported. We describe a case of refractory ventricular dysrhythmia following a large glyphosate overdose.Case A 60-year-old male with a history of cardiovascular disease was found to be unresponsive. A half-empty 600 mL bottle of dark blue liquid, later confirmed to be glyphosate 680 g/L, was discovered nearby. On ambulance arrival, he was in cardiac arrest with ventricular fibrillation. He received in total, 27 defibrillation shocks, epinephrine (4 mg), amiodarone (300 mg), lignocaine (150 mg), and mechanical cardiopulmonary resuscitation. He had intermittent output with an electrocardiograph revealing sinus rhythm with a nonspecific interventricular conduction delay. Sustained return of spontaneous circulation was achieved at 90 minutes. The serum glyphosate concentration at hospital arrival was 190 mg/L. He was managed supportively and extubated on day 6. He had a complicated course over the next two weeks, with delirium and recurrent aspiration events. He developed severe colitis and passed away on day 25.Discussion Ventricular dysrhythmia in glyphosate poisoning is rare and may be related to surfactant-induced cardiac ion channel disruption. Systemic acidosis further exacerbates myocardial instability, contributing to cardiotoxicity and poor clinical outcomes.