Urea fertilizer poisoning-induced multiorgan failure: Case report

Abstract

Background: Urea agricultural products normally have low toxicity. However, most of the severe poisoning occurs after urea ingestion, which causes gastrointestinal symptoms. There is no robust evidence about inhalation or topical exposure; however, in animals, it has been documented dyspnea, methemoglobinemia, carboxyhemoglobin, hemorrhages, and brain degenerative changes. Case report: A 31-year-old male without medical history had a fainting episode prior to the use of urea fertilizer. Laboratory tests showed a progressive increase in renal function, from 1.47 mg/dl up to 10 mg/dl requiring renal replacement therapy, and remarkably high aminotransferase levels. Also an aspartate aminotransferase and alanine aminotransferase at 10150 U/L and 2150 U/L, were reported respectively. The clinical manifestations progressed to respiratory failure, requiring invasive mechanical ventilation for 10 days with successful extubation and a return to normal saturation without supplemental oxygen. Discussion: Urea poisoning due to agricultural product use is a rare condition. In this exceptional case, our patient presented with a life-threatening condition. Even though it is not well-established as a standard treatment, management with intravenous methylene blue can improve the symptoms associated with methemoglobinemia, provide breathing support, and prevent renal damage or the use of renal replacement therapy in cases of acute renal failure. Conclusion: Reports of urea herbicide poisoning are extremely rare, and little is known about how to effectively manage urea poisoning as it normally presents mild symptoms. Correct identification of the agricultural product causing the poisoning is crucial to direct therapeutic efforts.

Keywords

• fertilizers
• urea
• poisoning
• toxicity
• methylene blue