A Farmer Mistakenly Drank His Own Herbicide.
This Is What Happened To His Organs. GW is a 41-year-old man, presenting to
the emergency room sweaty and panicked. He tells the admitting nurse that he took a
swig out of what he thought was a new sports drink bottle, but the liquid inside,
wasn’t a sports drink. Very quickly, a chemical test is done on his urine
and it confirms to the medical team, what happened. They ask him for advanced
directives, because they need to sedate him and take control of his body to try and
mitigate everything that’s about to happen. And they need word from him on what to do, in
case this is the last time he’s ever conscious. GW was a farmer in Middle America. Earlier that
summer, he had been doing landscaping on his lot. To save some space in the barn, he thought
to consolidate some of his leftover chemicals into smaller bottles. On hand, he had a couple
of these sports drinks. Some weren’t opened, some were partially consumed, but “labeling
everything clearly will prevent any accidents,” he thought as he poured herbicide into an empty
bottle. But in the shuffle, he put an herbicide label on a bottle that didn’t have herbicide
in it, and the liquids all looked alike. Near a barn, on his land, months later. GW noticed
some weeds that kept growing that shouldn’t have been there. He had sprayed here before, but seems
like he needed to spray again. He got his backpack sprayer. It still had some herbicide left in
it from before, and he started spraying. He thought to bring some extra chemical with him
just in case he needed to refill the sprayer, and he brought some sports drink too,
just in case he needed a break in the sun. After hours in the field, GW sat down to catch his
breath. He was so thirsty, he had been sweating for so long because it was so hot and humid
outside. He unscrewed the cap without looking. And took a big gulp. The moment it touched his
tongue he knew something was wrong, but he had already swallowed it , when he didn’t want to do
that. Immediately, he knew-- that wasn’t sports drink going down his throat and realized that he
had put the wrong label on the wrong bottle. GW starts to panic. Whatever he swallowed, needs to
get out of his body, as he runs towards his house. In the bathroom now, GW tried the best he could
to empty his stomach, but the more he tried, the more panicked he got. A burning sensation
lined his esophagus and he could feel heat in his abdomen. A clear liquid came up. Unsure if he
got any of it out, and knowing that the closest hospital was at least 40 minutes away, he got into
his car and started driving. On the way there, he felt like an animal was chewing a hole
through his guts. He wasnt sure if this was the herbicide or just his anxiety as he
arrives to the emergency room where we are now. At examination, GW’s heart rate and blood pressure
were sky high. He told the admitting nurse, what had happened- that he thought
he was going to have a sports drink, but instead drank herbicide. The moment this was
mentioned, the medical team immediately grabbed GW a tube of activated charcoal to swallow. The
charcoal particle surface allows for adhesion of toxic molecules. Technically, this should
inactivate the herbicide, and physically, it should prevent it from absorbing in to his
body and prevent it from flooding into his organs. But 2 hours had now passed since
GW accidentally swallowed the drink. The charcoal in his stomach, can’t inactivate
the herbicide that’s already in his blood. When they ask him what herbicide he drank, he
said he didn’t know. He had thrown away the bottle months ago. But having some idea, the medical
team get a sample of GW’s urine. They immediately put it into a chemical test from a kit prepared
for this exact situation. In the test tube, when solution is added to his urine, a dark green color appears.
This tells them exactly which herbicide GW drank. It tells them that it has now absorbed into his
body. It’s circulating around and it has reached his kidneys. And it tells them exactly what is
going to happen to him, in the next few hours. GW was using Diquat dibromide, something
that’s available off the shelf in most home improvement stores in the United States.
As an herbicide, it’s extremely effective, due to its properties derived
from its chemical structure. Plants use sunlight to conduct photosynthesis
to produce energy necessary for their survival. This process takes water and light to transport
an electron through a chain with the end result of energy and oxygen produced. Electrons are
subatomic particles that are associated with energy, and you may know it best as the
basis of electricity. But when diquat is sprayed onto the plant, the chemical takes
away that electron used for photosynthesis and incorporates it into itself. This
chemical reaction is known as reduction, because electrons are negatively charged, and
gaining an electron REDUCES the charge number by 1. Then, oxygen that’s normally inside
the plant comes in contact with this reduced diquat. They react. Oxygen pulls that electron
off, reducing itself, before it goes on to cause problems. Diquat is then available to
steal electrons again, and it doesn’t stop. Photosynthesis no longer happens because
the herbicide has disrupted normal electronic flow. The reduced oxygen,
desperate to make itself normal again, reacts with several structures in the plant, not
only disturbing other normal functions, but also destroying key structures necessary for survival.
As the diquat endlessly cycles through electrons, the plant has no mechanism of eliminating it.
Photosynthesis is shut down, starving the plant, while permanent damage is done to cells inside
the plant, completing the herbicidal action. Plants and humans are completely
different beings, but inside our bodies, the same mechanism of diquat cycling electrons
causing permanent damage plays out the same way. 30 minutes after arriving to the emergency room,
GW was told, of his impending multi-organ failure. That an initial insult is going to happen, in the
next few minutes. And even if they sedate him to put a tube down his throat so that a machine can
breathe for him, and the medical team can try to support every necessary-for-life function in
his body as best they can, there is a chance it’s too late. He might not wake up after this.
As he gives the medical team advance directives for what is about to happen, they notice that
his heart rate and blood pressure are now half of what they were when he arrived to the emergency
room. He’s starting to become lethargic and blue in the face. GW says what could be good bye to his
family as he’s transported upstairs the hospital. In the intensive care unit, doctors find that
GW has oliguria. Oligo meaning little or small, and uria referring to urine. His urine output
is low, and knowing that he drank diquat, he was placed on dialysis. His blood is diverted
to a machine that “cleans” his blood and sends it back to his body, a function that’s supposed to
be performed by the kidneys, but can’t be now, because toxic diquat is circulating around
his body. But this wasn’t his only problem. A camera was sent down his esophagus, and
the images showed irritation and ulceration all indicating damage along the inner lining of
his stomach, where the herbicide was in contact. This brings us back to chemical structure. Diquat
is a bipyridyl herbicide. Bi meaning two and Pyridyl referring to Pyridine, a molecule
that has high affinity for electrons. Do you remember that oxygen in plants that reacts
with reduced diquat? Well, nature tends towards stability. Put another way, nature wants things
to have less energy. The opposite case of that, is something has too much energy, and
because the tendency is to have less energy, a high energy body will give that extra energy
to surrounding structures. In this case, it will do that by reacting with what’s
around it. This not only disturbs normal function but it will also break off and destroy
existing structures, causing permanent damage. In humans, Diquat takes electrons from normal
functioning processes, just like it does in plants. And it mindlessly does that nonstop. Our
oxygen, isn't different from the one in plants, so, inside our cells, it also pulls electrons
from reduced diquat creating superoxide. Normally, living beings have protective systems in
place to handle superoxide to prevent them from doing damage. Usually, superoxide
is converted to hydrogen peroxide, which is then neutralized into water. But
diquat was never eliminated. It doesn’t get removed from cells. It endlessly cycles back
and forth creating more and more superoxide, overwhelming and depleting
all protective mechanisms. A final pathway opens up, but it isn’t
protective. A hydroxyl radical is created, something that rips apart cells, destroying them.
Diquat doesn’t change, it doesn’t stop, and the body can’t do anything about it, as it floats
around causing damage in every single organ. As the hours pass, the medical team notes
that GW is starting to go into shock. His blood pressure keeps dropping. The heart has
4 chambers. Blood from the veins drain into the right atrium where it’s held until accepted
by the right ventricle, which pumps blood into the lungs so that carbon dioxide can be
exchanged out for oxygen. From the lungs, blood drains into the left atrium where it’s
held before going to the left ventricle, where that oxygenated blood is pumped out
of the heart to the rest of the body. As doctors look at GW’s heart rhythm, they
can see his left ventricular dysfunction, from damage being done by diquat. If this part of
the heart stops beating, the body will no longer receive any blood causing a life threatening
emergency. But luckily, all of this can still be managed by medicines that the medical team
administer through his IV lines, at least for now. When medicines or toxins are taken by mouth,
they go from the esophagus to the stomach and into the small intestines, where they absorb
into the liver first. Typically, the liver will automatically metabolize, or break down, a large
portion of the ingested dose. In metabolism, the liver is trying to make the chemical more stable,
so that it can't start reacting with parts of the body causing damage. But GW’s problem is, diquat
doesn’t get metabolized. It goes to the liver. Causes damage. Flows out. Causes more damage
elsewhere before returning again. As expected, a blood test finds that GW’s liver has started
shutting down because parts of it have started to die, and are now leaking enzymes into his
blood. The only way of eliminating diquat from the body is in the urine through the
kidneys, but GW’s have completely shut down. The diquat has damaged GW's esophagus, and his
stomach, from the ulceration and the swelling. It’s damaged his heart, judged by the left
ventricular dysfunction. His kidneys shut down just a few hours after he presented to
the emergency room because he had stopped making urine. Parts of his liver have sloughed
off and are now floating around in his blood, the same blood that has also shut down
and is no longer able to hold onto oxygen, because electrons have been taken
from the iron in the hemoglobin, due to the fact that GW’s body is now under
massive amounts of oxidative stress. Almost every single organ in his body has been affected
so far, except for his lungs and his brain. 9 Days after GW presented to the emergency room,
the medical team sends him in for a scan of his head. Because he was intubated shortly after he
arrived to the hospital, he was sedated so that a machine could breathe for him but he was also
paralyzed using medicines so that full control of his body could be taken to try to manage his
impending multi-organ failure. As a result, the medical team can’t talk to him. They
can’t ask him questions to see his level of consciousness. He can’t move so they can't
tell if those parts of his brain responsible for motor function are operational. But what they
did notice was that GW’s pupils were dilated, when they weren't dilated before. And,
those pupils wouldn’t react to light. Typically, when light is shined into the eyes,
the pupils will constrict so as to limit the amount of light going in. This is a natural
reflex that happens in normal function of the brain. When they dont react, it means something
is wrong. And in GW, something was wrong. The scan shows that abnormalities have appeared
in his brainstem, that weren’t there before. Scans as the days pass, show a progressive
worsening of GW’s midbrain. At first, it appeared swollen with fluid. But as more
time passes, the brainstem starts to look like it’s starving of oxygen, something called
an infarction. And while the medical team knows this is happening, there isn’t
anything they can actively do at the moment to stop or reverse this effect
because diquat has no known antidote. We know that outside of living beings,
this chemical immediately deactivates and is no longer toxic the moment it touches
soil. Before activated charcoal was used, patients were sometimes given bentonite
clay and fullers earth to eat, in the hopes that the herbicide would bind and become
inactivated in the stomach. We understand why diquat did the damage that it did to
GW’s kidneys, to his heart, and his lungs, in the days after he initially drank what
he thought was a sports drink. But why did damage not appear in his brain until several
days after he presented to the emergency room? This brings us back to diquat’s electron cycling.
In plants, all available mechanisms to protect against superoxide get exhausted. The resulting
hydrogen peroxide then takes an electron from an iron containing compound in Photosystem 1
called ferredoxin, shutting down photosynthesis. In humans, this hydrogen peroxide also takes
an electron from iron. But for us, instead of photosystems, we have iron in the hemoglobin
of our blood cells. Stealing electrons there, makes it so that our blood can no longer carry
oxygen, which was something happening to GW, explaining why he started to become
blue in the face just after he arrived to the emergency room. But in his brain, the
location where all the damage was happening, is the area where the Red Nuclei are. These are
somewhat responsible for helping us control and coordinate movement, but they’re red due to the
presence of iron. And in diquat poisoning cases where brainstem infarcts are documented,
most of them occurred around this area, possibly because of the role of iron assisting the
non-stop Diquat redox cycling. But the reality is, we still are not entirely sure exactly why
it happens this way to the brainstem. We just know that it can happen if the patient
survives the ingestion long enough. Bipyridal heribicide ingestions can be
survivable. If they are treated very early, and the patient didnt drink more than a
couple drops, the initial organ failure may not be so severe. But there’s still a
percentage of people who will go on to get a brainstem injury days later. It’s documented that
patients may look ok for days in the hospital, but then quickly become unresponsive,
ending with permanent brain damage. Often, we hear much about herbicides,
pesticides, lawn and landscaping and farming chemicals that can be dangerous.
Commonly at home improvement stores, you will find glyphosate based herbicides,
which is not a bipyridyl compound. And it appears that these consumer products
are in lower concentrations than what you would find with commercial, agricultural
use. At least in the acute toxicity setting, the effects are not the same level of
impending doom, for a single gulp ingested. A newly documented mechanism of cell death
involving iron and lipid peroxidation from reactive oxygen species is called ferroptosis.
Understanding this mechanism, if it is even taking place in the setting of diquat poisoning, might
be able to help understand what other therapies could be used, because bipyridyl herbicides
don’t currently have a known antidote. Diquat isn’t the only herbicide in
this class. Much more common than Diquat is the chemical Paraquat, which
in the United States is categorized for restricted use in agriculture and cannot
be purchased at home improvement stores. GW’s lungs never completely shut down and the
medical team didn’t have to worry about permanent damage, because Diquat can’t absorb into the
lungs in the same way as Paraquat, which causes irreversible, permanent lung damage because of
a special quality involving the space between nitrogens, in this case, part of the pyridyl
moieties. Paraquat can also be absorbed through certain parts of the skin in massive quantities,
all of this described in this video, that you can watch and is launching first on Nebula, a
streaming service that was created by creators. Nebula has a huge catalog of Nebula Originals
from all sorts of creators like Real Engineering, RealLifeLore, Wendover Productions and almost
200 others. They’ve made shows, documentaries, films, plays and Nebula is able to offer this
thanks to funding that comes in from subscribers, who in addition to getting all of these, also get
early access to these creators’ regular videos, ad free. This Paraquat video, I can speak a little
bit more directly on Nebula about what exactly happened, cause, well you can see the title.
This is a different route of administration, and the toxicity plays out a bit differently
because of that, but also due to a small change in the chemical structure. I happen to subscribe
to Nebula myself, paid for with my own money, and it’s awesome to see stuff like their travel
game show, Jet-Lag The Game. It’s cool for me, because, I know a lot of these creators, I had met
them in person for the first time many years ago, and now I have the opportunity to
be a part of Nebula with them. So if you sign up at nebula.tv/chubbyemu, or
click the link in the description below, you will receive a huge 40% off a yearly
subscription, which comes down to $2.50 a month, and you’ll get access to the whole platform,
and you’ll see in this video I can describe a medical case in a way that I wouldn’t
otherwise be able to. That’s that patient. For GW, it’s too late. 17 days after presenting
to the emergency room, an erratic heart rhythm appeared. It developed into a situation where
the left ventricle started shaking in place, not actually coming to a full contraction
to move blood throughout the body. Several minutes pass as the medical try to do CPR to
try to resuscitate him, and to get his heart rhythm somewhat normal. But, the medical team
was not able to resuscitate him. Following the advanced directives given by GW before he was
intubated, he was returned back to his family. This was an accident that unfortunately
isn’t that uncommon. Chemicals like this should never be put in food containers
or food packaging. Always separate, and always put very far away in distance
from one another to try to make it as unlikely as possible for anyone to
ever get these chemicals their body. Thanks so much for watching. Take
care of yourself. And be well.
