Takotsubo cardiomyopathy as a delayed complication with a herbicide containing glufosinate ammonium in a suicide attempt: a case report

Abstract

Background. Glufosinate ammonium has a famous delayed complication as respiratory failure, however, delayed cardiogenic complication is not well known. Objectives. The aim of this study is to report a takotsubo cardiomyopathy as a delayed complication of glufosinate ammonium for suicide attempt. Case Report. A 75-year-old woman ingested about 90 mL of Basta, herbicide for suicide attempt at arousal during sleep. She came to our hospital at twelve hours after ingesting. She was admitted to our hospital for fear of delayed respiratory failure. Actually, she felt down to respiratory failure, needing a ventilator with intubation at 20 hours after ingesting. Procedure around respiratory management had smoothly done with no delay. Her vital status had been stable, however, she felt down to circulatory failure and diagnosed as Takotsubo cardiomyopathy at about 41 hours after ingestion. There was no trigger activities or events to evoke mental and physical stresses. Conclusion. We could successfully manage takotsubo cardiomyopathy resulted in circulatory failure in a patient with glufosinate poisoning for suicide attempt. Takotsubo cardiomyopathy should be taken into consideration if circulatory failure is observed for unexplained reasons.

Figure 1

These images show echocardiography obtained at circulatory failure (41 hours after taking Basta) through cardiac cycle. There is akinesis lesion from mid to apex of left ventricle (LV) through cardiac cycle (white arrow). Meanwhile, there is hyperkinetic motion at base of LV.

Figure 2

These images show transition of electrocardiogram. Times after ingestion of glufosinate were set as horizontal axes. “41 hours” means the time at onset of Takotsubo cardiomyopathy. Transit ST segment elevation and typical negative T wave were seen in precordial leads through clinical course.