A Farmer Sprayed 1 Liter of Herbicide In-Between
His Legs. This Is How His Organs Shut Down. PT is a 43-year-old man, presenting to the emergency room
with chest pain, and scrotal eczema. He tells the admitting nurse that he could
feel his heartbeat in between his legs, because sores and strange wounds started
appearing there over the last several days, but all of that was because the “medicine”
that he was applying to the area, was working. PT was a farmer living in the country with
his wife. One day, he had to sneak in his own house. It was 4 in the morning. He had too much to
drink but he told his wife that he was going out with the boys. As he creeped into his bed room, he
knew if he woke her up, he wouldn’t wake up alive, because he had been to a place and had
an encounter that he shouldn't have had. PT’s secret meeting that night came with what
he believed was punishment from God. After the events of that evening, he thought he
felt what was at first a dull burning sensation from under the shaft crawling up
just below his belly button every time he needed to urinate. But as the time passed, he
was convinced that there was discharge present there. He thought he could see it. He thought he
could smell it. But at other times in the day, he just wasn’t sure if something was really there
or if this was all just in his mind. Sometimes, he’d scratch, and he couldn’t stop scratching
because the area would get itchier and itchier. One day, PT was in the fields spraying
herbicide to get rid of some weeds, and an idea popped into his head.
Sometimes, when he’d really dig in, he’d sometimes end up with chips of flaked-off
skin in his hands. If plant leaves slough off when herbicide is applied and new foliage
appears underneath, this is just like skin, so applying herbicide between his legs
should strip away and exfoliate what’s there, leaving layers underneath anew. He knew that
he for sure had an infection in this area from his encounter that one night, so applying this
should fix all of his problems, he thought. In the bathroom, PT took a small amount
of herbicide and diluted it in water. He soaked a paper towel in it, and started
rubbing all over the shaft, the scrotum, and the perineum. Because he couldn’t see all the
way in there, he took the tingling sensation he felt as confirmation that it was working.
Some medicines you take 2 or 3 times a day, so he thought to apply this herbicide at the same
frequency, taking 10 minutes per treatment. A few days into doing this, PT in the shower
noticed something with his scrotal skin. It was painful, swollen, and starting to slough
off. Clearly, his treatment was working. If 2 or 3 times a day was producing results, 4
times would be better. If 10 minutes works, then 20 minutes would clearly be optimal, as
he started soaking his perineum in herbicide, and putting a diaper on to increase contact
time so that the chemical can do its magic. As the days pass, PT continues his treatment,
but he starts to notice that his chest would feel tight. In-between his legs felt tender,
it even hurt to walk because the skin of his legs would rub together in that area, but
that just means the herbicide is working! But finally, the hurt was too much. It was
getting harder to breathe. This had been going on for at least 7 days now. PT went to
an Urgent Care in the town nearby. They told him to stop wiping his groin in herbicide and
to stop putting a diaper over it. They didn’t know which herbicide it was, and they didn’t
ask. They concluded that it probably doesn’t get through the skin. But they noticed some
of the damage and injury that appeared there, and washed and cleaned the area telling
him that things should be fine if he just stops applying the chemical there.
But things weren’t going to be fine. In the morning, PT woke up and felt like he
was suffocating. The moment he got out of bed the pain in his crotch was unbearable.
His wife asked him what was wrong but he didn’t answer. He got into his car and drove
himself to the emergency room where we are now. At physical examination, the medical
team found that PT’s blood pressure and heart rate were normal. His breathing
appeared to be labored. When they saw the wounds between his legs, they
saw the area was swollen, eroded, with bloody scabs. Scrotal skin was bleeding
and it was ulcerated and parts of it appeared to be necrosed. They noticed on his legs a dark
colored liquid that appeared to have splashed, or rubbed on, likely from the diaper that
they had to peel off to examine the area. When asked what this was, he told the medical
team what he’d been doing over the last few days. When they asked which herbicide it was, he
showed them a picture of the bottle on his phone. Immediately, the medical team
get a chemical test and obtain a sample of PT’s urine. In the test
tube, a deep blue color appeared, and this gives the medical team
some clues as to what’s happening. The herbicide that PT rubbed on his body
is Paraquat, used in agriculture in the United States under restricted-use,
due to the fact that its misuse can result in fatal toxicities. However, the
mechanism whereby it exerts that toxicity, is why it’s so effective as an herbicide, and
all of this derives from its chemical structure. Plants use sunlight to conduct photosynthesis to
produce energy necessary for their survival. Water and light are used 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 their movements are responsible for
electricity. But when Paraquat is sprayed onto the plant, it has an extreme affinity for
1 electron to get sucked into its structure. Electrons are negatively charged, so when
a chemical gains and incorporates that electron into its structure, its total charge
reduces by one, so we’d say that Paraquat gets reduced. Oxygen is abundant in plants, and it
comes into contact with this reduced Paraquat. They react. Oxygen takes the electron, reducing
itself, before it goes on to cause permanent damage. Paraquat is then available to
steal more electrons, cycling nonstop. This disruption of biochemical equilibrium is the
primary driver of Paraquat’s herbicidal mechanism, but, this exact same mechanism plays out
the same way INSIDE humans. But PT never put it inside his body. It was only ever
on his skin. So, what’s happening here? When the medical team did the urine test,
the deep blue color confirmed the presence of Paraquat. This means that it isn’t just inside
his body, but that Paraquat is floating around in his blood, so much so, that his kidneys
have started collecting and filtering it, and excreting it in his urine. All of this
meaning that PT’s topical application of Paraquat, has resulted in systemic absorption. And because
he soaked his perineum, his scrotum, and the shaft in so much Paraquat for so many days, the total
amount in his body could be as if he drank it. The medical team take a blood test and find
that PT’s liver and his kidneys are shutting down. Thinking that there couldn’t have been
that much that absorbed through his skin, they elect to wash the area between his
legs, to give him some antibiotics just in case those wounds are starting to get
infected, and to rehydrate him and push water into his body so that his kidneys
can function again. But it wasn’t enough. The following day, PT complains to the medical
team that the pain between his legs is worse than it was the day before. Despite the area
being cleaned, and no more Paraquat present, the bleeding on all those parts was more severe
than before. But even worse, he tells them that it feels like a rubber band is being tied
around his chest, because he’s struggling to breathe. The medical team noticed that his
abdomen is now swollen, and another blood test finds PT is going into multi-organ failure, and
that there isn’t enough oxygen in his blood. This brings us back to chemical structure.
Paraquat is a bipyridyl herbicide. Bi meaning two and Pyridyl referring to Pyridine, a molecule that
has high affinity for electrons. Another herbicide in this class is Diquat, something that you can
get off the shelf in home improvement stores in the United States. Do you remember that oxygen in
plants that reacts with reduced Paraquat? Well, that pathway tracks in humans too.
The resulting superoxide radical, is reactive. Nature tends towards stability. When
something is reactive, another way to describe it, is that it’s unstable. And in order to stabilize
itself, it needs to react with SOMETHING. We know that matter is conserved, meaning that
it is neither created nor destroyed. So if something is unstable, and to stabilize
itself it reacts with something else, then a transfer of matter occurs at this
time. For a biological system, a change in structural integrity out of the ordinary,
because of the actions of a reactive compound, means permanent damage happening. It means
that normal function can’t occur anymore. But humans have innate stores of chemicals that
can prevent damage done by superoxide and the hydrogen peroxide that results from it. These
protective mechanisms can have a high capacity to function, resulting in the hydrogen peroxide
getting neutralized into water, which isn’t toxic. But when Paraquat is in the body, it doesn’t
stop cycling electrons, creating huge amounts of superoxide and exerting oxidative stress.
Protective mechanisms quickly become overwhelmed. As the hours pass, PT starts to fall in and
out of consciousness. Because his oxygen level in blood was low, the medical team gave him
some supplemental oxygen through a mask. But his condition kept getting worse. All of this
telling the medical team that the severity of PT’s poisoning, is as if he drank Paraquat. And
it only takes a small sip of it, to be fatal. Typically, when substances are applied dermally, they don’t usually result in systemic toxicity.
The skin has proteins and specialized structures to protect the body from external pathogens.
But PT’s situation is a little different. The scrotum is highly vascularized, meaning
that there’s a lot of blood vessels and a large blood supply flowing through the region.
Because it’s slightly offset from the body, in an effort to give gametes an environment
to thrive that's cooler than body temperature, the skin is thinner than the skin on the arms
and the legs. Scrotal skin also has many folds and wrinkles in it, meaning that should the area
not be properly dried before clothing is put on, liquid contact time can increase. But PT didn’t
just quickly rinse this area in Paraquat, he immersed the shaft, the scrotum and the
perineum, applying a large amount. But then he didn’t clean it off and put a diaper over it,
dramatically increasing the contact time that Paraquat had with his skin. In a small science
experiment, the scrotum was found to absorb creams rubbed on it at a rate 42 times more than when
those same creams were applied on the forearm, meaning compounds can potentially absorb more
through this area than anywhere else. And Paraquat didn’t just dry up and evaporate like water would,
it stayed there until he applied it a second, and third and a fourth time, all in a single
day, before he did it again the next. Paraquat absorbs through skin, especially the kind that’s
known to absorb a lot of what’s applied to it. But then the wounds started appearing.
The area was ulcerated, with blood scabs, meaning that when he did his reapplication,
it was applied over damaged skin, creating additional opportunity for Paraquat
to leak into his body systemically. PT was placed on dialysis, where his blood
was diverted to a machine so that it could be filtered and cleaned for him, because
his kidneys had completely shut down. The liver normally metabolizes, and breaks down
chemicals in the body, neutralizing them. But Paraquat doesn’t get metabolized. The
only way to get it out of the blood, is through the kidneys. But getting it out of
the blood, doesn’t get rid of what’s already absorbed into his organs. As Paraquat reaches an
equilibrium, flowing back and forth between organs and the blood, the one place that it appears
to be accumulating in PT’s body, is his lungs. You see, cells in the lungs are known to
have a pump for a kind of chemical called a polyamine. Poly meaning many and amine
referring to a functional group involving nitrogen. These chemicals have many nitrogens,
and they’re involved in normal function in cells, and on lung cells, they purposely pump
chemicals where the nitrogens are separated by point six to point seven nanometers. The
problem is, Paraquat is a chemical with two nitrogens separated by exactly that distance,
meaning, in the lungs, Paraquat is pumped in and heavily concentrated, to the point where
the amount in Lung tissue, is 50 times the amount in the blood. The lungs have no mechanism
to pump this Paraquat out. And as it enters cells, it cycles electrons endlessly, but the problem is
made worse, because of the function of the lungs. Do you remember that Oxygen is involved in
reacting with reduced Paraquat? Well, the lungs are the first place in the human body where
fresh oxygen is received from breathing in. If Paraquat is ultra concentrated in the lungs, and
oxygen accepts the electron stolen by Paraquat, going on to start a cascade of massive cellular
damage, then it means PT’s trouble breathing that’s been happening for days before he presented
to the emergency room, is actually his lung tissue dying, with permanent damage being done. The body
detects this, and sends the immune system in, causing inflammation and even more damage, all
at a time when Paraquat stays concentrated in the lungs, continuing to cause damage. And
it won’t stop until PT stops breathing. When the medical team realized that PT had
Paraquat in his urine, they sent a sample of his blood to test for the amount of Paraquat
present. Days later, the result returned. Paraquat ingestions were recorded with
meticulous detail over several years, and survival probability can be determined
based on Paraquat level in the blood, and how many hours post ingestion the patient
is. PT’s Paraquat level was Zero Point Five (0.5) micrograms per milliliter. But his Hours After
Ingestion was unclear, because he didn’t drink it, but rather dermal absorption became systemic
toxicity. And because he was symptomatic for at least a day before he presented to the
emergency room, he is well beyond 24 hours. As the day passes, PT was struggling to breathe,
but the medical team couldn’t give him too much oxygen because it would worsen his condition,
quicker. Bipyridal herbicides do not have any antidote. There isnt any way to easily remove
it from the blood, and there isn’t any way to suck it out of his organs. And there isnt
any way to regrow the parts of his lungs that have already died. At 6 days after he
initially presented to the emergency room, the medical team noticed that PT had an erratic
heart rhythm. It developed into a situation where his heart started shaking in place, not actually
coming together to make a full contraction to move blood throughout the body. The medical
team try to do CPR to resuscitate him, and to get his heart beating again, but
they were not able to bring him back. At autopsy, widespread lung fibrosis was found in
PT consistent with systemic Paraquat poisoning. There’s a wide range of herbicides out now.
Some are not toxic in humans when ingested. But old houses, farms, agricultural areas
in the United States will still use and have Paraquat. Controls have been put in place
to restrict its use, but around the world, this poisoning still happens, and often enough
to be in the news couple times a month. Thanks so much for watching.
Take care of yourself. And be well.
https://www.tandfonline.com/doi/abs/10.1081/CLT-100102470?journalCode=ictx19
https://journals.physiology.org/doi/full/10.1152/ajplung.2000.278.3.L417
