A Case Series on 2, 4-Dichlorophenoxyacetic Acid Poisoning Mimicking Organophosphorus Toxicity: Treatment Approaches and Outcomes

Dr. Dhiresh Kumar, Dr. Ramchandra B. Burute, Dr. Shreyas Ramchandra Burute

Abstract: Background: 2, 4-Dichlorophenoxyacetic acid (2, 4-D) is a widely used herbicide in agricultural regions, particularly in South Asia. Its ingestion, often with suicidal intent, can closely mimic organophosphorus (OP) poisoning, resulting in frequent misdiagnosis and delayed targeted therapy. Limited clinical literature exists on the diagnostic and therapeutic approach to 2, 4-D toxicity. Objective: To describe the clinical presentation, diagnostic challenges, treatment strategies, and outcomes in a series of patients with 2, 4-D poisoning, with a focus on differentiating it from OP toxicity and emphasizing the role of urinary alkalinization. Methods: We retrospectively studied cases of 10 patients with confirmed or strongly suspected 2, 4-D poisoning admitted to the emergency department of Government Medical College, Miraj, Maharashtra (India). Clinical data including presenting symptoms, laboratory findings, treatment interventions, and outcomes were analyzed. Results: All patients presented with gastrointestinal and neuromuscular symptoms mimicking of OP poisoning. However, preserved Glasgow Coma Scores, normal plasma cholinesterase levels, and lack of response to atropine/pralidoxime raised suspicion for alternative diagnoses. Metabolic derangements, including hypernatremia and elevated anion gap metabolic acidosis, were prominent. Early initiation of urinary alkalinization and supportive therapy led to full recovery in all cases, with no ICU admissions or fatalities. Conclusion: 2, 4-D poisoning is a frequently misdiagnosed yet clinically distinct toxidrome that requires high diagnostic vigilance. Metabolic abnormalities and neuromuscular signs provide critical diagnostic clues. Early urinary alkalinization is a safe, effective adjunct that may significantly improve outcomes. Emergency clinicians should maintain a high index of suspicion to avoid therapeutic misadventures in cases of unknown agricultural poisoning.

Keywords: 2, 4-D poisoning; organophosphorus mimicry; metabolic acidosis; urinary alkalinization; herbicide toxicity; emergency medicine; misdiagnosis