Circulation

For hypotension due to herbicide poisoning, first-line treatment is intravenous fluid resuscitation. If hypotension persists, start inotropic support. Initially use noradrenaline (norepinephrine) or adrenaline (epinephrine)—see Noradrenaline (norepinephrine) intravenous infusion instructions for advice on preparation and administration of noradrenaline, and Adrenaline (epinephrine) intravenous infusion instructions for advice on preparation and administration of adrenaline.

Additional inotropic therapy is guided by the patient’s haemodynamics. Bedside echocardiography is useful to determine the relative contributions of negative inotropy and vasodilation to hypotension, and hence guide treatment choice—discuss with a clinical toxicologist.