# A Case of Acute Human Self-Poisoning With Bispyribac Sodium Presenting as Lactic Acidosis

## TL;DR

A 65-year-old man was hospitalized with lactic acidosis after self-poisoning with bispyribac sodium, a herbicide, and recovered with symptomatic treatment.

## Contribution

This case report highlights the rare and potentially life-threatening presentation of bispyribac sodium poisoning as lactic acidosis.

## Key findings

- The patient presented with lactic acidosis and high anion gap metabolic acidosis after ingesting bispyribac sodium.
- Symptomatic care and monitoring led to the patient's recovery with normalization of lactate levels.
- Herbicide poisoning can present as lactic acidosis, challenging differential diagnosis in emergency settings.

## Abstract

This case report describes a 65-year-old male who presented to the emergency department with significant lactic acidosis after self-poisoning by ingesting bispyribac sodium, a commonly known herbicide. This case highlights the rarity of poisoning with freely available herbicides in the literature, which may be elusive in clinical history and life-threatening in presentation. The patient had attempted to commit suicide with ingestion of an unidentified herbicide and was brought to the emergency department post two hours after the incident. He complained of abdominal pain. The hemodynamics of the patient were within normal limits. However, his initial lactate levels were elevated along with a high anion gap metabolic acidosis. The patient was provided symptomatic care and close monitoring. The ingested substance was later found to be bispyribac sodium. The patient symptomatically improved over time, with lactate levels attaining normal ranges, and was discharged after observation of 24 hours. Human ingestion of bispyribac sodium is mostly asymptomatic and non-fatal. The management in this case mainly consisted of symptomatic care. The initial presentation of herbicide poisoning in an emergency department setting as lactic acidosis and the subsequent evaluation to rule out other possible causes of lactic acidosis in the patient was challenging for the treating physician. The possibility of herbicide-mediated cellular damage and subsequent lactic acidosis is thought to be the reason for this rare presentation.