Circulation
Commence continuous ECG monitoring and assess serial 12-lead ECGs for at least 24 hours after ingestion of more than 1.5 mL/kg of glyphosate concentrate.
Hypotension can develop several hours after glyphosate ingestion. First-line treatment is intravenous fluid resuscitation, but judicious fluid administration is required due to the risk of acute pulmonary oedema. If hypotension persists, start inotropic support in consultation with a clinical toxicologist.
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 guides treatment choice—discuss with a clinical toxicologist.
After glyphosate poisoning, there is a risk of late cardiac arrest. For cardiorespiratory arrest and life-threatening arrhythmias, follow advanced life support protocols1 and seek advice from a clinical toxicologist. Correct hyperkalaemia urgently if present (see Treating hyperkalaemia).