A Decade of Glyphosate–Surfactant Poisoning in India: Clinical Patterns and Predictors of Mortality

A Decade of Glyphosate–Surfactant Poisoning in India: Clinical Patterns and Predictors of Mortality | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Decade of Glyphosate–Surfactant Poisoning in India: Clinical Patterns and Predictors of Mortality Dr Sanjan Asanaru kunju, Dr Ahlam Abdul Rahman, Dr Sachin Nayak Sujir, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9260842/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Glyphosate–surfactant herbicide (GlySH) poisoning is increasingly reported in low- and middle-income countries, yet data on clinical predictors of mortality remain limited, particularly from the Indian subcontinent. This study aimed to describe the clinical profile of GlySH poisoning and to identify predictors of in-hospital mortality in a tertiary-care setting in South India. Methods We conducted a retrospective observational study of consecutive adult patients with confirmed oral GlySH ingestion presenting to a tertiary-care emergency department between January 2009 and July 2019. Demographic, clinical, and laboratory variables were extracted from electronic medical records. In-hospital mortality was the primary outcome. Associations between clinical variables and mortality were assessed using univariate logistic regression and Fisher’s exact test, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Multivariable analysis was not performed due to the small number of outcome events. Results A total of 51 patients were included, of whom four (7.8%) died. Most patients were young adults (45.1% aged 25–44 years), male (76.5%), and had suicidal intent (62.7%). In univariate analysis, shock (OR 14.67, 95% CI 1.50–143.74), altered sensorium (OR 14.63, 95% CI 1.34–159.23), and elevated serum creatinine >1.4 mg/dL (OR 25.2, 95% CI 2.19–290.23) were strongly associated with in-hospital mortality. Dialysis requirement showed a non-significant trend toward higher mortality, whereas liver transaminases and respiratory distress were not significantly associated with mortality. Conclusion In this 10-year cohort, mortality following GlySH poisoning was closely associated with shock, altered sensorium, and early renal dysfunction, reflecting advanced systemic involvement. These readily identifiable features may assist in risk stratification and triage of high-risk patients in the emergency setting. Given the small number of outcome events, these findings should be interpreted as hypothesis-generating, and larger multicentric prospective studies are required to validate these predictors. Glyphosate herbicide poisoning mortality predictors acute kidney injury retrospective study India Figures Figure 1 Introduction Glyphosate–surfactant herbicides (GlySH) are among the most widely used non-selective systemic herbicides globally, with applications spanning large-scale agriculture, forestry, and domestic weed control. In Low- and Middle-Income Countries (LMICs), they are easily available to the public, which has led to many cases of acute poisoning. Although GlySH Poisoning exhibits lower mammalian toxicity, it can still cause acute poisoning, and the commercial formulations of glyphosate that include surfactants, such as POEA (polyethoxylene amine), are far more corrosive and toxic. ( 1 , 2 ). Experimental models and clinical studies have shown that the surfactants are responsible for the majority of the hemodynamic collapse, metabolic dysfunction, and multi organ failure, ( 3 ). Numerous global studies on GlySH poisoning report clear differences in severity, with mortality rates reaching up to 30% for cases of intentional poisoning with the added focus of concentrated formulations. ( 4 – 6 ) The degree of toxicity is also affected by the amount of time that is taken to seek medical help, the surfactants in the herbicide, and the glyphosate acid equivalent that are in the herbicide. Typical clinical manifestations include gastrointestinal corrosive injury, vomiting, diarrhea, hypotension, pulmonary edema, acute kidney injury (AKI), arrhythmia, hyperkalemia, and metabolic acidosis. ( 2 , 7 ) Severe toxicity typically involves some combination of direct mucosal damage, mitochondrial disruption, and systemic inflammatory response caused not by glyphosate, but by surfactant components. ( 1 , 3 ) Pesticide-related deaths represent a significant public health burden in low- and middle-income countries (LMICs). Although these countries use pesticides less than other regions, they account for 99% of fatal pesticide poisoning. This is because, in LMICs, pesticide use is poorly regulated, pesticides are poorly stored, are widely available for household use, and the countries have limited critical care infrastructure for treating severe cases. ( 8 , 9 ) India is one such setting where the increased accessibility to herbicides, including formulations based on GlySH Poisoning, has led to an increased incidence of toxic exposures. The use of herbicides has increased significantly in the past few years, which is associated with changes in agricultural practices, including the mechanization of agriculture, and the reduction of available agricultural labor. However, the local understanding of the toxicity of GlySH Poisoning is often insufficient, and because GlySH is branded as a "low-toxicity" product, people often delay seeking medical attention after ingestion. There is not much published data on GlySH poisoning in India, with most clinical data on GlySH poisoning involving East Asian studies from Taiwan, South Korea, and Japan. ( 4 , 6 , 10 ) These regions have different surfactant compositions, formulation strengths, agricultural practices, and health care systems compared to Indian regions. For example, East Asian formulations are POEA (surfactant) rich, while Indian formulations have varying glyphosate acid concentrations and may have different co-formulants. This heterogeneity raises questions about whether mortality predictors identified internationally such as shock, hyperkalemia, acidosis, elevated lactate, and depressed sensorium are applicable to Indian populations. Additionally, differences in prehospital care, delayed presentation from rural areas, and the quality of first point of contact care, further justify the need for locally generated evidence. Another major challenge in managing GlySH poisoning is the absence of a verified clinical risk-stratification tool. Unlike the proven prognostic systems available for poisoning with paraquat or organophosphates, the available literature is sparse and clinicians have to make subjective judgment calls regarding the severity. This ambiguity is particularly problematic when determining ED triage, making ICU admission decisions, and when implementing aggressive supportive care. In health systems with limited resources, as is the case with many lower and middle-income countries (LMICs), early identification of patients with a high risk of deterioration is vital in order to prevent avoidable deaths and make the best use of limited critical-care resources. Existing research indicates that early hemodynamic instability, changes in level of consciousness, respiratory distress, metabolic acidosis, hyperkalemia, and increased levels of creatinine correlate with an increase in mortality. ( 4 , 6 , 7 , 10 ) Renal dysfunction in particular, reflected by increased serum creatinine or need for renal replacement therapy, has been linked to more severe toxicity and poorer outcomes. However, these studies mainly come from outside of India, so their applicability on rural and semi-urban Indians remains unknown. Additionally, the different levels of surfactant and different toxicity profiles of surfactant available in India could lead to different patterns of clinical outcomes. Given the critical gaps in the research, the collection of region-specific clinical data on GlySH poisoning in India is necessary. The overall clinical presentation, exposure and demographic patterns, laboratory markers, complications, and determinants of mortality provide valuable insight into the clinical decision-making processes in Emergency Departments (ED), ultimately aiding the formulation of uniform management protocols. Furthermore, such data is also vital in informing and shaping public health policies, regulation of pesticides, education of communities, and the prevention of suicides. This study seeks to address these gaps by reviewing ten years of GlySH poisoning cases at a South Indian tertiary-care hospital. The study's focus is to define the clinical and laboratory findings in patients with confirmed GlySH ingestion and to determine the predictors of mortality. This study analyzes the clinical progression, complications, and outcomes of GlySH poisoning in the Indian context using real-world data for the past ten years. These results will help refine ED triage algorithms, improve resource allocation, and strengthen evidence-based risk stratification tools applicable to low- and middle-income countries (LMIC) health systems. Materials and Methods Study Design and Setting We conducted a retrospective observational study of GlySH poisoning cases at a 1,500-bed tertiary-care teaching hospital in South India, which receives about 50,000 visits per year in its Emergency Department (ED). The study covered all adult patients documented to have orally ingested GlySH during the period of study from January 2009 to July 2019. Selection bias was minimized by including all eligible consecutive cases during the study period. An approval from the Institutional Ethics Committee was obtained before data abstraction. (IEC No. 179/2019; IRB Registration ECR/146/Inst/KA/2013/RR-16; approval date: 7 August 2019). To preserve a consistent pre-COVID-19 cohort and to reduce variability due to changes in the health care systems after the pandemic, we excluded cases occurring after 2019. Because the study is retrospective and utilizes anonymized electronic medical records, the need for informed consent was waived. Data was de-identified completely prior to analysis, and the study was compliant with institutional and international ethical regulations for the protection of human subjects in research. Case Identification and Selection of Participants Eligible participants included adults aged 18 years and older with documented oral ingestion of GlySH formulations. Possible cases were found using the International Classification of Diseases, Tenth Revision (ICD-10) with discharge coding of T60 within the hospital EMR system. Due to the ICD-10 coding system not being specific to GlySH exposures, each record was manually reviewed using a case identification algorithm. A case was confirmed for GlySH ingestion if documented oral ingestion was recorded, there was no documented co-exposure to other pesticides, and at least one of the following was satisfied: (i) the product label was visually confirmed to contain glyphosate; (ii) there was documentation of a commercial brand that is known to contain glyphosate; or (iii) caregivers who presented the container or brand name and confirmed the brand. In the laboratory, there was no glyphosate confirmation, as is the customary practice in our setting. Exclusion criteria consisted of exposure history that was uncertain, co ingestion of other pesticides, exposure that was not by the oral route, discharge against medical advice, transfer to another health care facility, the individual being under 18 years of age, and missing essential information. Missing essential information included the absence of definitional outcome data (survival status) or definitional clinical data (blood pressure, serum creatinine, or level of consciousness). Paediatric cases were excluded due to varying toxicokinetic and weight-based dosing factors, differences in airway and renal physiology, and treatment protocols that necessitate separate evaluations. Data Abstraction and Quality Assurance Data abstraction was performed by two emergency medicine residents under faculty supervision using a standardised data collection form. Abstractors were trained specifically on study objectives, EMR navigation, standard operating procedures, and a de-identified case study before beginning any data collection. Data were extracted in duplicate to improve reliability. Discrepancies were resolved by consensus or adjudication by a senior faculty investigator. Because outcome status was available in discharge records, blinding to outcomes was not feasible. To minimize bias, abstractors adhered to predefined variable definitions and recorded objective clinical and laboratory values obtained within the first 24 hours of presentation. Inter-rater agreement for key variables was assessed in a random 10% sample of records, and discrepancies were resolved by consensus with a senior investigator. Data audits and quality checks were performed regularly to ensure completeness and verify data accuracy. Patient Management and Clinical Protocols All patients were managed according to a standardized institutional protocol aligned with international toxicology and critical-care guidelines. Management followed recommendations from the American Academy of Clinical Toxicology (AACT), the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) on gastrointestinal decontamination, and the EXTRIP workgroup on extracorporeal therapies. (21–24) Initial evaluation followed the airway–breathing–circulation (ABC) approach with continuous hemodynamic monitoring. Early resuscitation targeted a mean arterial pressure (MAP) ≥65 mmHg using balanced crystalloids, with norepinephrine as the first-line vasopressor when indicated. Activated charcoal was administered only within one hour of ingestion when the airway was protected; gastric lavage was generally avoided. Hemodialysis was performed exclusively for standard metabolic indications, including refractory hyperkalemia, severe metabolic acidosis, or oliguric acute kidney injury (AKI), and not for toxin removal. Data Variables and Exposure Assessment Data was gathered pertaining to demographic variables (age, sex, occupation, marital status), exposure intent (suicidal, accidental, occupational), estimated ingestion volume, and time intervals from ingestion to ED arrival (12 h). Clinical variables included presenting symptoms, vital signs, and laboratory parameters obtained within 24 hours. We recorded pre-hospital and in-hospital interventions, need for mechanical ventilation or renal replacement therapy, length of hospital stays, ICU admission, complications, and survival status. Ingested volume was recorded using standardized descriptive units adapted from prior literature: spoon (5 mL), mouthful (25 mL), cup (100 mL), and bottle (300 mL). (4) Because volume estimates were self-reported in broad categories and only four deaths occurred, formal dose–response modelling was not feasible. Nausea and vomiting were analyzed as a composite variable in comparative analysis. Pre-hospital treatment was defined as any intervention provided before ED arrival, including gastric lavage at referring centers, intravenous fluids, and symptomatic care. Operational Definitions of Outcomes In-hospital mortality following GlySH ingestion was considered the primary outcome. Secondary outcomes included the development of shock, altered sensorium, AKI, respiratory distress, need for dialysis or mechanical ventilation, ICU admission, and length of hospital stay. Shock was defined as systolic blood pressure <90 mmHg or MAP <65 mmHg sustained for ≥30 minutes, or requirement of vasopressors after adequate fluid resuscitation, with clinical evidence of hypoperfusion.(25) Altered sensorium was defined as any new impairment in consciousness attributable to poisoning, including Glasgow Coma Scale (GCS) ≤13, a ≥2-point decline in GCS, AVPU scores of P or U, or documented confusion, agitation, or coma.(26,27) Patients with post-sedation symptoms within six hours of the last sedative dose were excluded. AKI was defined using KDIGO criteria: urine output <0.5 mL/kg/h for ≥6 hours, an increase in serum creatinine ≥0.3 mg/dL within 48 hours, or ≥1.5-fold increase from baseline within three months. (28) Early renal dysfunction was defined as the presence of acute kidney injury or a serum creatinine level >1.4 mg/dL documented within the first 24 hours of presentation to the emergency department. When baseline creatinine was unavailable, the lowest in-hospital creatinine was used as reference. Elevated creatinine >1.4 mg/dL was analyzed separately as a severity marker. Arrhythmia was defined as any rhythm other than normal sinus rhythm documented on ECG. Conservative management referred to supportive care without dialysis or mechanical ventilation. Sample Size and Effect Size Justification All consecutive eligible cases during the 10 years were included (N=51; deaths=4). We determined the sample size based on case availability rather than power calculation. We avoided multivariable regression analysis because only four deaths occurred to prevent model overfitting and unstable estimates. Accordingly, the study focused more on describing effect sizes with 95% CIs to illustrate the strength and precision of the associations, instead of emphasizing formal p-value–based hypothesis testing. Given the small number of deaths (n = 4), all statistical associations should be interpreted with caution Statistical analysis Statistical analysis was done using IBM SPSS Statistics Version 26.0. Continuous variables were tested for normality with a summary given by mean ± standard deviation (SD) or median (interquartile range, IQR) as appropriate. Categorical variables were summarized into frequencies and percentages and were tested using the Chi-square or Fisher’s exact tests. Univariate logistic regression analysis was done to determine associations of the predictors with mortality and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sparse or empty tables were adjusted using the Haldane–Anscombe correction and exact CIs along with Fisher’s exact p-values were reported. Due to the limited number of deaths these analyses are centered on effect size and causal inferences cannot be definitively drawn. A p-value of < 0.05 was considered statistically significant. Results Characteristics of study subjects Our initial patient identification yielded 63 patients with ICD-10 T60 discharge codes. Nine patients were excluded: three had uncertain exposure histories, two had co-exposure to other pesticides, three were discharged against medical advice, one was under 18 years of age. Three patients had essential data missing and were excluded from the final analysis. Following the exclusion criteria, 51 patients were included in the final analysis. (Figure 1). Baseline Demographic and Clinical Characteristics The study cohort included 51 patients with confirmed GlySH poisoning (Table 1). Most of the patients were aged 25-44 years (45.1%), with the majority of the patients being males (76.5%). Agricultural workers constituted 29.4% of cases, and most patients were married (70.6%). Suicidal intent was reported in 62.7% of exposures. Pre-hospital interventions were frequent: 80.4% underwent gastric lavage, and 7.8% received activated charcoal. Most patients were managed conservatively without dialysis or mechanical ventilation (88.2%). Mechanical ventilation was required in 9.8%, and dialysis in 11.8% of cases. Common presenting symptoms included vomiting (70.6%), nausea (68.6%), abdominal pain (21.6%), and altered sensorium (21.6%). The overall in-hospital mortality rate was 7.8% (4/51). (Table 1) Comparison Between Survivors and Non-Survivors Comparisons between survivors (n = 47) and non-survivors (n = 4) are shown in Table 2. Non-survivors were older than survivors (median 44.5 vs. 34.5 years, p < 0.05). There was no significant difference in sex distribution (p = 1.00) or pre-hospital treatment (p = 0.10) between groups. Among presenting symptoms, fever was more frequent among non-survivors than survivors (50.0% vs. 2.1%, p < 0.05). Abdominal pain, nausea/vomiting, and respiratory distress were more frequent among non-survivors but did not reach statistical significance. Shock (50.0% vs. 6.4%, p = 0.04) and altered sensorium (75.0% vs. 17.0%, p = 0.015) were significantly more common among non-survivors. (Table 2) Laboratory Parameters and Mortality Initial laboratory parameters are summarized in Table 3. There were no significant differences in haemoglobin, white blood cell count, or platelet count between survivors and non-survivors. Among biochemical parameters, serum albumin (median 3.9 vs. 4.5 g/dL, p = 0.007) and total protein levels (median 6.4 vs. 7.3 g/dL, p = 0.024) were significantly lower among non-survivors. Direct bilirubin levels were significantly higher among non-survivors (median 1.1 vs. 0.2 mg/dL, p = 0.009), whereas total bilirubin did not differ significantly. Liver transaminases (AST and ALT) were higher among non-survivors but did not reach statistical significance. Serum potassium levels were also higher among non-survivors but did not reach statistical significance (p = 0.06). Univariate Predictors of Mortality Univariate logistic regression analysis is shown in Table 4. Elevated serum creatinine >1.4 mg/dL was present in all non-survivors and was strongly associated with mortality (OR 25.2, 95% CI 2.19–290.23; p = 0.0003). Altered sensorium (OR 14.63, 95% CI 1.34–159.23; p = 0.026) and shock (OR 14.67, 95% CI 1.50–143.74; p = 0.041) were also significantly associated with mortality, demonstrating strong positive associations despite wide confidence intervals due to the small number of outcome events. Dialysis requirement showed a trend toward higher mortality but did not reach statistical significance (OR 10.75, 95% CI 1.18–98.15; p = 0.06). Although AST and ALT levels were higher among non-survivors, they were not significantly associated with mortality in univariate regression analysis. Respiratory distress was also not significantly associated with mortality. (Table 4) Discussion In this 10-year retrospective cohort of patients with GlySH poisoning, shock, altered sensorium, and early renal dysfunction emerged as the strongest clinical predictors of in-hospital mortality. The primary objective of this study was to identify clinical and biochemical predictors of adverse outcomes in patients with GlySH poisoning presenting to a tertiary-care centre in South India. With the escalating global use of glyphosate-based herbicides and the corresponding rise in reported toxicity, understanding the clinical spectrum and prognostic indicators of GlySH poisoning remains highly relevant for both clinical management and public health interventions. Our findings reaffirm that although most patients recover with supportive therapy, mortality is closely associated with markers of multiorgan dysfunction—particularly shock, altered sensorium, renal impairment, and hepatic injury. This study recorded a demographic profile of young adults between 25 and 44 years of age, mostly males, and frequently working in agricultural settings. This phenomenon has been documented in both domestic and international studies, where increased exposure risk is described as a consequence of occupational exposure. The occurrence of poisoning among students and the non-agricultural population shows that GlySH ingestion is not solely occupational but also due to the easy accessibility of the substance at home. Large Asian cohorts have shown similar trends, including the Korean study by Seok et al. that found intentional ingestion to be the most common means of exposure, highlighting the role of formulation toxicity in adverse outcomes. ( 29 – 31 ) These outcomes highlight the importance of community education, better access to mental health care, and the need for regulatory control of the pesticide trade as a means of preventing poisoning. ( 18 , 33 ) In contrast to some cohorts, age and sex were not significant predictors of mortality in our study. This is likely due to the limited number of deaths (n = 4), which constrains the statistical power to detect demographic associations. The high prevalence of suicidal intent, observed in nearly two-thirds of patients in our study, is similar to global reports identifying GlySH Poisoning as a common means of attempted self-poisoning due to their widespread availability and perceived lethality. ( 34 ) The clinical spectrum of GlySH poisoning in our cohort was heterogeneous and included mainly gastrointestinal manifestations but also atypical presentations such as altered sensorium and excessive salivation. ( 34 ) Fever was significantly more pronounced in non-survivors. Although this observation is based on a small number of events, it has been documented for severe pesticide poisonings and may represent an early systemic inflammatory response, infection due to aspiration, or developing sepsis in patients with high-grade toxicity, and it is an observation that requires further studies in larger prospective cohorts. Laboratory abnormalities provided important insights into the pathophysiology of severe GlySH toxicity. Hypoalbuminemia and reduced total protein suggest systemic inflammation and capillary leaks, while renal dysfunction reflects disease severity. Although liver enzyme levels were higher among non-survivors, these differences were not statistically significant in our cohort. This is consistent with previous studies showing that surfactant-rich formulations cause direct mucosal and cellular injury, leading to fluid losses, vasoplegia, renal hypoperfusion, and hepatic dysfunction. ( 14 , 34 ) As seen in the reports from the Korean and Sri Lankan cohorts, renal dysfunction was a prominent feature associated with mortality, underscoring the prognostic importance of early kidney injury in this setting. Importantly, the variables identified as predictors in this study -shock, altered sensorium, and elevated creatinine- should be interpreted as markers of advanced systemic toxicity rather than independent causal determinants of death. Given the retrospective design and sparse number of events, these findings indicate a late stage in the trajectory of multiorgan failure rather than modifiable risk factors. Accordingly, our data do not support causal inferences regarding the effect of specific interventions on survival. Instead, they highlight the need for prompt recognition of hemodynamic instability and renal impairment as indicators of high-risk disease requiring close monitoring and aggressive supportive care. Analysis of treatment patterns in this cohort highlighted that most patients improved with conservative management, illustrating the value of supportive therapy with mild to moderate poisoning. However, the subset of patients requiring mechanical ventilation and renal replacement therapy underscores the marked heterogeneity in clinical severity. Our results, along with the EXTRIP recommendations, reinforce the principle that hemodialysis, when done, should be prescribed based on the usual metabolic criteria (i.e., refractory acidosis, hyperkalemia, and oliguric acute kidney injury) rather than for the purpose of toxin removal. In summary, this study demonstrates that most patients with GlySH poisoning can be managed with supportive care measures, and mortality is closely associated with patients with shock, altered sensorium, and early renal dysfunction, reflecting advanced multiorgan involvement. Further, larger multicentric prospective studies with formulation-specific data are needed to validate these findings and develop standardized risk-stratification tools for clinical practice. Limitations This study has several important limitations, most of which relate to its retrospective design. Incomplete or inconsistent medical records may have resulted in information bias, with potential underreporting or misclassification of key variables such as ingested volume, time to presentation, and laboratory parameters. Selection and spectrum bias are also likely, as our cohort may overrepresent more severe cases presenting to a tertiary-care centre, while patients with mild symptoms who did not seek hospital evaluation were not captured. Consequently, the clinical spectrum and mortality estimates may not fully reflect community-level exposure patterns. Establishing prospective regional registries with standardized data collection and follow-up would help capture the full range of disease severity in future studies. The small number of outcome events (n = 4 deaths) substantially limited statistical power, precluded multivariable modelling, and resulted in wide confidence intervals around several effect estimates. All associations should therefore be interpreted as exploratory and hypothesis-generating rather than definitive. Residual confounding is likely, as important factors such as exact ingested dose, formulation composition, baseline renal function, co-morbidities, and delays in treatment could not be fully accounted for. In addition, only short-term in-hospital outcomes were assessed; potential long-term sequelae involving renal, hepatic, or neurological function were not evaluated and require prospective follow-up. The single-centre design further limits the generalizability of our findings to other regions where glyphosate formulations, patterns of exposure, and access to healthcare may differ. Finally, laboratory confirmation and quantitative measurement of glyphosate were unavailable, precluding formulation-specific analyses and dose–response assessment. These limitations underscore the need for cautious interpretation and external validation. Conclusion This 10-year cohort study demonstrates that although most patients with GlySH poisoning recover with supportive care, in-hospital mortality is closely associated with shock, altered sensorium, and early renal dysfunction, reflecting advanced multiorgan involvement. These readily identifiable clinical and biochemical features may assist in early risk stratification and triage of high-risk patients in the emergency and resource-limited settings. Given the small number of outcome events and the retrospective design, these findings should be interpreted as hypothesis-generating rather than definitive. Larger, multicentric prospective studies with formulation-specific toxicological data are required to validate these predictors and to develop standardized risk-stratification tools for clinical practice. Declarations Presentation(s) or Awards at a meeting This work has not been presented at any meetings nor published as an abstract Source(s) of Support and Funding The authors report that no external funding or support was received for this article. Ethical Approval The study received approval from the Institutional Research Board (IRB)/Institutional Ethics Committee, with registration numbers ECR/146/Inst/KA/2013/RR-16 and IEC: 179/2019, dated 7th August 2019. This study was conducted retrospectively using de-identified patient data. The requirement for informed consent was waived by the Institutional Ethics Committee due to the retrospective nature of the study. Confidentiality of patient information was strictly maintained Conflict of Interest statement The authors declare no conflicts of interest related to this work. Author contributions statement S.A.K., V.G., and S.N.S. contributed to the conceptualization, study design, and methodology development. S.A.K., B.P.R., and S.S. performed data collection and data entry. S.A.K., A.A.R., and S.S. conducted data curation and validation. S.A.K. and A.A.R. performed formal data analysis and statistical interpretation. S.A.K. and A.A.R. wrote the main manuscript text and prepared the tables and figures. S.A.K., V.G., S.N.S., B.P.R., and S.S. contributed to critical revision of the manuscript for important intellectual content. S.A.K., V.G., and S.N.S. provided supervision and overall project oversight. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. Consent to Participate This study was conducted retrospectively using de-identified patient data from hospital records. As such, obtaining informed consent from participants was not feasible. However, all ethical guidelines were strictly followed, and the study received approval from the Institutional Ethics Committee. 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Improving global outcomes (KDIGO) acute kidney injury work group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1–138. Cha ES, Khang YH, Lee WJ. Mortality from and incidence of pesticide poisoning in South Korea: findings from National Death and Health Utilization Data between 2006 and 2010. PLoS One. 2014;9(4):e95299. Kamaruzaman NA, Leong YH, Jaafar MH, Khan HRM, Rani NAA, Razali MF, et al. Epidemiology and risk factors of pesticide poisoning in Malaysia: a retrospective analysis by the National Poison Centre (NPC) from 2006 to 2015. BMJ Open. 2020;10(6):e036048. Van Der Hoek W, Konradsen F. Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health. 2005;10(6):589–96. Banerjee I, Tripathi S, Roy AS, Sengupta P. Pesticide use pattern among farmers in a rural district of West Bengal, India. Journal of natural science, biology, and medicine. 2014;5(2):313. Martínez Caballero MA, Rodríguez JL, López Torres B, Martínez Caballero M, Martínez Larrañaga MR, Maximiliano Guerra JE, et al. Use of human neuroblastoma SH-SY5Y cells to evaluate glyphosate-induced effects on oxidative stress, neuronal development and cell death signaling pathways. 2020; Roberts DM, Buckley NA, Mohamed F, Eddleston M, Goldstein DA, Mehrsheikh A, et al. A prospective observational study of the clinical toxicology of glyphosate-containing herbicides in adults with acute self-poisoning. Clin Toxicol. 2010;48(2):129–36. Tables Table 1 Demographic characteristics of GlySH poisoning Demographic Characteristic n (%), n=51 Age Range 15-24 years 20 (39.2%) 25-44 years 23 (45.1%) 45-64 years 6 (11.8%) 65+ years 2 (3.9%) Gender Male 39 (76.5%) Female 12 (23.5%) Occupation Agriculture 15 (29.4%) Student 10 (19.6%) Laborer 8 (16.7%) Business 4 (7.8%) Unemployed 14 (27.5%) Marital Status Married 36 (70.6%) Unmarried 15 (29.4%) Intent of Exposure Suicidal 32 (62.7%) Stress-related 8 (15.7%) Unknown 9 (17.6%) Ingested Amount (volumetric units) A spoon (5 mL) 8 (15.7%) A mouthful (25 mL) 10 (19.6%) A cup (100 mL) 20 (39.2%) A bottle (300 mL) 6 (11.8%) Missing data 7 (13.7%) Elapsed Time (hours) 12 10 (19.6%) Missing data 8 (15.7%) Clinical manifestation Nausea 35 (68.6%) Vomiting 36 (70.6%) Diarrhoea 5 (9.8%) Abdominal Pain 11 (21.6%) Sore throat 7 (13.7%) Dysphagia 2 (3.9%) Hematemesis 3 (5.9%) Oral ulcers 2 (3.9%) Altered sensorium 11 (21.6%) Excessive salivation 2 (3.9%) Chest pain 2 (3.9%) Fever 3 (5.9%) Syncope 2 (3.9%) Treatment Modality Prehospital treatment 34 (66.7%) Gastric Lavage 41 (80.4%) Activated Charcoal 4 (7.8%) Conservative management 45 (88.2%) Mechanical Ventilation 5 (9.8%) Dialysis 6 (11.8%) Abbreviation: GlySH, Glyphosate-surfactant herbicide; mL, Milliliter Table 2 Clinical characteristics and outcomes in patients with GlySH toxicity: A comparative analysis of survivors and non-survivors Survivors (n = 47) Deceased (n = 4) Total (n = 51) Fisher’s Exact p-value Age in years (Median, IQR) 34.5 (19.5-34.5) 44.5 (34.5-54.5) 34.5 (19.5-34.5) <0.05 Gender Distribution (male/female) 36/11 3/1 39/12 1.00 Pre-hospital Treatment (Yes/No) 33/14 1/3 34/17 0.10 Symptom Abdominal Pain, n (%) 9 (19.1%) 2 (50.0%) 11 (21.6%) 0.20 Nausea/Vomiting, n (%) 43 (91.5%) 4 (100.0%) 47 (92.2%) 1.00 Fever, n (%) 1 (2.1%) 2 (50.0%) 3 (5.9%) < 0.05 Intervention/Complication Mechanical Ventilation, n (%) 4 (8.5%) 1 (25.0%) 5 (9.8%) 0.35 Dialysis, n (%) 4 (8.5%) 2 (50.0%) 6 (11.8%) 0.06 Shock, n (%) 3 (6.4%) 2 (50.0%) 5 (9.8%) 0.04 Altered Sensorium, n (%) 8 (17.0%) 3 (75.0%) 11 (21.6%) 0.026 Respiratory Distress, n (%) 8 (17.0%) 2 (50.0%) 10 (19.6%) 0.15 Suicide Attempt 28 (59.6%) 4 (100.0%) 32 (62.7%) 0.28 Abbreviation: GlySH, Glyphosate-surfactant herbicide; IQR, Interquartile range. Table 3 Comparison of initial haematological and biochemical parameters between survivors and deceased patients in GlySH Toxicity Parameter Survivors, n = 47, Median (IQR) Deceased, n = 4, Median (IQR) p-value Hematological Parameters Haemoglobin (g/dL) 14.2 (13.5–14.9) 14.1 (13.5–14.4) 0.89 WBC Count (10 9 /L) 12.1 (11.3–13.4) 13.1 (12.7–13.5) 0.74 Platelet Count (10³/mm³) 259 (248–269) 259 (256–263) 0.98 Biochemical Parameters Total Bilirubin (mg/dL) 0.6 (0.4–0.9) 1.7 (1.1–4.5) 0.56 Direct Bilirubin (mg/dL) 0.2 (0.2–0.3) 1.1 (0.4–2.3) 0.009 Albumin (g/dL) 4.5 (4.2–4.9) 3.9 (3.3–4.1) 0.007 Total Protein (g/dL) 7.3 (6.8–7.6) 6.4 (5.7–6.7) 0.024 AST (IU/L) 39 (28–53) 49 (34–81) 0.73 ALT (IU/L) 27 (18–44) 42 (33–61) 0.18 ALP (IU/L) 76 (59–103) 80 (62–108) 0.83 Electrolytes Sodium (mEq/L) 139 (136–142) 137 (135–139) 0.43 Potassium (mEq/L) 4.2 (3.9–4.5) 4.9 (4.3–5.5) 0.06 Abbreviations: GlySH, Glyphosate-surfactant herbicide; IQR, Interquartile range; g/dL, grams per deciliter; WBC, white blood cell count; mg/dL, milligrams per deciliter; U/L, Units Per Liter; mmol/L, Millimoles per liter. Table 4 Predictors of mortality and clinical outcomes in GlySH Poisoning Predictors Survivors, n/N (N = 47) Deceased, n/N (N = 4) Total, n/N, (%) (N = 51) Odds Ratio (95% CI) Elevated Creatinine (>1.4mg/dl) 4/47 4/4 8 (8/51, 15.7%) 25.2 (2.19 - 290.23) Elevated AST (>40 IU) 22/47 3/4 25 (25/51, 49.0%) 3.41 (0.333 - 35.030) Elevated ALT (>42 IU) 7/47 2/4 9/51, (17.6%) 5.71 (0.60 – 54.69) Dialysis 4/47 2/4 6/51 (11.8%) 10.75 (1.18 – 98.15) Shock 3/47 2/4 5/51 (9.8%) 14.67 (1.50 – 143.74) Altered Sensorium 8/47 3/4 11/51 (21.6%) 14.63 (1.34 – 159.23) Respiratory Distress 8/47 2/4 10/51 (19.6%) 4.88 (0.49 – 48.18) Abbreviations: GlySH, Glyphosate-surfactant herbicide; mg/dL, milligrams per deciliter; U/L, Units Per Liter; mmol/L. Additional Declarations No competing interests reported. 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In Low- and Middle-Income Countries (LMICs), they are easily available to the public, which has led to many cases of acute poisoning. Although GlySH Poisoning exhibits lower mammalian toxicity, it can still cause acute poisoning, and the commercial formulations of glyphosate that include surfactants, such as POEA (polyethoxylene amine), are far more corrosive and toxic. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Experimental models and clinical studies have shown that the surfactants are responsible for the majority of the hemodynamic collapse, metabolic dysfunction, and multi organ failure, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Numerous global studies on GlySH poisoning report clear differences in severity, with mortality rates reaching up to 30% for cases of intentional poisoning with the added focus of concentrated formulations. (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) The degree of toxicity is also affected by the amount of time that is taken to seek medical help, the surfactants in the herbicide, and the glyphosate acid equivalent that are in the herbicide. Typical clinical manifestations include gastrointestinal corrosive injury, vomiting, diarrhea, hypotension, pulmonary edema, acute kidney injury (AKI), arrhythmia, hyperkalemia, and metabolic acidosis. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Severe toxicity typically involves some combination of direct mucosal damage, mitochondrial disruption, and systemic inflammatory response caused not by glyphosate, but by surfactant components. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePesticide-related deaths represent a significant public health burden in low- and middle-income countries (LMICs). Although these countries use pesticides less than other regions, they account for 99% of fatal pesticide poisoning. This is because, in LMICs, pesticide use is poorly regulated, pesticides are poorly stored, are widely available for household use, and the countries have limited critical care infrastructure for treating severe cases. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) India is one such setting where the increased accessibility to herbicides, including formulations based on GlySH Poisoning, has led to an increased incidence of toxic exposures. The use of herbicides has increased significantly in the past few years, which is associated with changes in agricultural practices, including the mechanization of agriculture, and the reduction of available agricultural labor. However, the local understanding of the toxicity of GlySH Poisoning is often insufficient, and because GlySH is branded as a \"low-toxicity\" product, people often delay seeking medical attention after ingestion.\u003c/p\u003e \u003cp\u003eThere is not much published data on GlySH poisoning in India, with most clinical data on GlySH poisoning involving East Asian studies from Taiwan, South Korea, and Japan. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) These regions have different surfactant compositions, formulation strengths, agricultural practices, and health care systems compared to Indian regions. For example, East Asian formulations are POEA (surfactant) rich, while Indian formulations have varying glyphosate acid concentrations and may have different co-formulants. This heterogeneity raises questions about whether mortality predictors identified internationally such as shock, hyperkalemia, acidosis, elevated lactate, and depressed sensorium are applicable to Indian populations. Additionally, differences in prehospital care, delayed presentation from rural areas, and the quality of first point of contact care, further justify the need for locally generated evidence.\u003c/p\u003e \u003cp\u003eAnother major challenge in managing GlySH poisoning is the absence of a verified clinical risk-stratification tool. Unlike the proven prognostic systems available for poisoning with paraquat or organophosphates, the available literature is sparse and clinicians have to make subjective judgment calls regarding the severity. This ambiguity is particularly problematic when determining ED triage, making ICU admission decisions, and when implementing aggressive supportive care. In health systems with limited resources, as is the case with many lower and middle-income countries (LMICs), early identification of patients with a high risk of deterioration is vital in order to prevent avoidable deaths and make the best use of limited critical-care resources.\u003c/p\u003e \u003cp\u003eExisting research indicates that early hemodynamic instability, changes in level of consciousness, respiratory distress, metabolic acidosis, hyperkalemia, and increased levels of creatinine correlate with an increase in mortality. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Renal dysfunction in particular, reflected by increased serum creatinine or need for renal replacement therapy, has been linked to more severe toxicity and poorer outcomes. However, these studies mainly come from outside of India, so their applicability on rural and semi-urban Indians remains unknown. Additionally, the different levels of surfactant and different toxicity profiles of surfactant available in India could lead to different patterns of clinical outcomes.\u003c/p\u003e \u003cp\u003eGiven the critical gaps in the research, the collection of region-specific clinical data on GlySH poisoning in India is necessary. The overall clinical presentation, exposure and demographic patterns, laboratory markers, complications, and determinants of mortality provide valuable insight into the clinical decision-making processes in Emergency Departments (ED), ultimately aiding the formulation of uniform management protocols. Furthermore, such data is also vital in informing and shaping public health policies, regulation of pesticides, education of communities, and the prevention of suicides.\u003c/p\u003e \u003cp\u003eThis study seeks to address these gaps by reviewing ten years of GlySH poisoning cases at a South Indian tertiary-care hospital. The study's focus is to define the clinical and laboratory findings in patients with confirmed GlySH ingestion and to determine the predictors of mortality. This study analyzes the clinical progression, complications, and outcomes of GlySH poisoning in the Indian context using real-world data for the past ten years. These results will help refine ED triage algorithms, improve resource allocation, and strengthen evidence-based risk stratification tools applicable to low- and middle-income countries (LMIC) health systems.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective observational study of GlySH poisoning cases at a 1,500-bed tertiary-care teaching hospital in South India, which receives about 50,000 visits per year in its Emergency Department (ED). The study covered all adult patients documented to have orally ingested GlySH during the period of study from January 2009 to July 2019. Selection bias was minimized by including all eligible consecutive cases during the study period. An approval from the Institutional Ethics Committee was obtained before data abstraction.\u0026nbsp;(IEC No. 179/2019; IRB Registration ECR/146/Inst/KA/2013/RR-16; approval date: 7 August 2019).\u003c/p\u003e\n\u003cp\u003eTo preserve a consistent pre-COVID-19 cohort and to reduce variability due to changes in the health care systems after the pandemic, we excluded cases occurring after 2019. Because the study is retrospective and utilizes anonymized electronic medical records, the need for informed consent was waived. Data was de-identified completely prior to analysis, and the study was compliant with institutional and international ethical regulations for the protection of human subjects in research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Identification and Selection of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEligible participants included adults aged 18 years and older with documented oral ingestion of GlySH formulations. Possible cases were found using the International Classification of Diseases, Tenth Revision (ICD-10) with discharge coding of T60 within the hospital EMR system. Due to the ICD-10 coding system not being specific to\u0026nbsp;GlySH\u0026nbsp;exposures, each record was manually reviewed using a case identification algorithm. A case was confirmed for GlySH ingestion if documented oral ingestion was recorded, there was no documented co-exposure to other pesticides, and at least one of the following was satisfied: (i) the product label was visually confirmed to contain glyphosate; (ii) there was documentation of a commercial brand that is known to contain glyphosate; or (iii) caregivers who presented the container or brand name and confirmed the brand. In the laboratory, there was no glyphosate confirmation, as is the customary practice in our setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criteria consisted of exposure history that was uncertain, co ingestion of other pesticides, exposure that was not by the oral route, discharge against medical advice, transfer to another health care facility, the individual being under 18 years of age, and missing essential information. Missing essential information included the absence of definitional outcome data (survival status) or definitional clinical data (blood pressure, serum creatinine, or level of consciousness). Paediatric cases were excluded due to varying toxicokinetic and weight-based dosing factors, differences in airway and renal physiology, and treatment protocols that necessitate separate evaluations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Abstraction and Quality Assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData abstraction was performed by two emergency medicine residents under faculty supervision using a standardised data collection form. Abstractors were trained specifically on study objectives, EMR navigation, standard operating procedures, and a de-identified case study before beginning any data collection. Data were extracted in duplicate to improve reliability. Discrepancies were resolved by consensus or adjudication by a senior faculty investigator. Because outcome status was available in discharge records, blinding to outcomes was not feasible. To minimize bias, abstractors adhered to predefined variable definitions and recorded objective clinical and laboratory values obtained within the first 24 hours of presentation. Inter-rater agreement for key variables was assessed in a random 10% sample of records, and discrepancies were resolved by consensus with a senior investigator. Data audits and quality checks were performed regularly to ensure completeness and verify data accuracy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Management and Clinical Protocols\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were managed according to a standardized institutional protocol aligned with international toxicology and critical-care guidelines. Management followed recommendations from the American Academy of Clinical Toxicology (AACT), the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) on gastrointestinal decontamination, and the EXTRIP workgroup on extracorporeal therapies. (21\u0026ndash;24)\u003c/p\u003e\n\u003cp\u003eInitial evaluation followed the airway\u0026ndash;breathing\u0026ndash;circulation (ABC) approach with continuous hemodynamic monitoring. Early resuscitation targeted a mean arterial pressure (MAP) \u0026ge;65 mmHg using balanced crystalloids, with norepinephrine as the first-line vasopressor when indicated. Activated charcoal was administered only within one hour of ingestion when the airway was protected; gastric lavage was generally avoided. Hemodialysis was performed exclusively for standard metabolic indications, including refractory hyperkalemia, severe metabolic acidosis, or oliguric acute kidney injury (AKI), and not for toxin removal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Variables and Exposure Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was gathered pertaining to demographic variables (age, sex, occupation, marital status), exposure intent (suicidal, accidental, occupational), estimated ingestion volume, and time intervals from ingestion to ED arrival (\u0026lt;6 h, 7\u0026ndash;12 h, \u0026gt;12 h). Clinical variables included presenting symptoms, vital signs, and laboratory parameters obtained within 24 hours. We recorded pre-hospital and in-hospital interventions, need for mechanical ventilation or renal replacement therapy, length of hospital stays, ICU admission, complications, and survival status.\u003c/p\u003e\n\u003cp\u003eIngested volume was recorded using standardized descriptive units adapted from prior literature: spoon (5 mL), mouthful (25 mL), cup (100 mL), and bottle (300 mL). (4) Because volume estimates were self-reported in broad categories and only four deaths occurred, formal dose\u0026ndash;response modelling was not feasible. Nausea and vomiting were analyzed as a composite variable in comparative analysis. Pre-hospital treatment was defined as any intervention provided before ED arrival, including gastric lavage at referring centers, intravenous fluids, and symptomatic care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definitions of Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn-hospital mortality following GlySH ingestion was considered the primary outcome.\u0026nbsp;Secondary outcomes included the development of shock, altered sensorium, AKI, respiratory distress, need for dialysis or mechanical ventilation, ICU admission, and length of hospital stay.\u003c/p\u003e\n\u003cp\u003eShock was defined as systolic blood pressure \u0026lt;90 mmHg or MAP \u0026lt;65 mmHg sustained for \u0026ge;30 minutes, or requirement of vasopressors after adequate fluid resuscitation, with clinical evidence of hypoperfusion.(25) Altered sensorium was defined as any new impairment in consciousness attributable to poisoning, including Glasgow Coma Scale (GCS) \u0026le;13, a \u0026ge;2-point decline in GCS, AVPU scores of P or U, or documented confusion, agitation, or coma.(26,27) Patients with post-sedation symptoms within six hours of the last sedative dose were excluded.\u003c/p\u003e\n\u003cp\u003eAKI was defined using KDIGO criteria: urine output \u0026lt;0.5 mL/kg/h for \u0026ge;6 hours, an increase in serum creatinine \u0026ge;0.3 mg/dL within 48 hours, or \u0026ge;1.5-fold increase from baseline within three months. (28) Early renal dysfunction was defined as the presence of acute kidney injury or a serum creatinine level \u0026gt;1.4 mg/dL documented within the first 24 hours of presentation to the emergency department. When baseline creatinine was unavailable, the lowest in-hospital creatinine was used as reference. Elevated creatinine \u0026gt;1.4 mg/dL was analyzed separately as a severity marker. Arrhythmia was defined as any rhythm other than normal sinus rhythm documented on ECG. Conservative management referred to supportive care without dialysis or mechanical ventilation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Effect Size Justification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All consecutive eligible cases during the 10 years were included (N=51; deaths=4). We determined the sample size based on case availability rather than power calculation. We avoided multivariable regression analysis because only four deaths occurred to prevent model overfitting and unstable estimates. Accordingly, the study focused more on describing effect sizes with 95% CIs to illustrate the strength and precision of the associations, instead of emphasizing formal p-value\u0026ndash;based hypothesis testing.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eGiven the small number of deaths (n = 4), all statistical associations should be interpreted with caution\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis was done using IBM SPSS Statistics Version 26.0. Continuous variables were tested for normality with a summary given by mean \u0026plusmn; standard deviation (SD) or median (interquartile range, IQR) as appropriate. Categorical variables were summarized into frequencies and percentages and were tested using the Chi-square or Fisher\u0026rsquo;s exact tests. Univariate logistic regression analysis was done to determine associations of the predictors with mortality and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sparse or empty tables were adjusted using the Haldane\u0026ndash;Anscombe correction and exact CIs along with Fisher\u0026rsquo;s exact p-values were reported. Due to the limited number of deaths these analyses are centered on effect size and causal inferences cannot be definitively drawn. A p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of study subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur initial patient identification yielded 63 patients with ICD-10 T60 discharge codes. Nine patients were excluded: three had uncertain exposure histories, two had co-exposure to other pesticides, three were discharged against medical advice, one was under 18 years of age. Three patients had essential data missing and were excluded from the final analysis. Following the exclusion criteria, 51 patients were included in the final analysis. (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Demographic and Clinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study cohort included 51 patients with confirmed GlySH poisoning (Table 1). Most of the patients were aged 25-44 years (45.1%), with the majority of the patients being males (76.5%). Agricultural workers constituted 29.4% of cases, and most patients were married (70.6%). Suicidal intent was reported in 62.7% of exposures.\u003c/p\u003e\n\u003cp\u003ePre-hospital interventions were frequent: 80.4% underwent gastric lavage, and 7.8% received activated charcoal. Most patients were managed conservatively without dialysis or mechanical ventilation (88.2%). Mechanical ventilation was required in 9.8%, and dialysis in 11.8% of cases. Common presenting symptoms included vomiting (70.6%), nausea (68.6%), abdominal pain (21.6%), and altered sensorium (21.6%). The overall in-hospital mortality rate was 7.8% (4/51). (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison Between Survivors and Non-Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparisons between survivors (n = 47) and non-survivors (n = 4) are shown in Table 2. Non-survivors were older than survivors (median 44.5 vs. 34.5 years, p \u0026lt; 0.05). There was no significant difference in sex distribution (p = 1.00) or pre-hospital treatment (p = 0.10) between groups.\u003c/p\u003e\n\u003cp\u003eAmong presenting symptoms, fever was more frequent among non-survivors than survivors (50.0% vs. 2.1%, p \u0026lt; 0.05). Abdominal pain, nausea/vomiting, and respiratory distress were more frequent among non-survivors but did not reach statistical significance. Shock (50.0% vs. 6.4%, p = 0.04) and altered sensorium (75.0% vs. 17.0%, p = 0.015) were significantly more common among non-survivors. (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Parameters and Mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitial laboratory parameters are summarized in Table 3. There were no significant differences in haemoglobin, white blood cell count, or platelet count between survivors and non-survivors. Among biochemical parameters, serum albumin (median 3.9 vs. 4.5 g/dL, p = 0.007) and total protein levels (median 6.4 vs. 7.3 g/dL, p = 0.024) were significantly lower among non-survivors. Direct bilirubin levels were significantly higher among non-survivors (median 1.1 vs. 0.2 mg/dL, p = 0.009), whereas total bilirubin did not differ significantly. Liver transaminases (AST and ALT) were higher among non-survivors but did not reach statistical significance. Serum potassium levels were also higher among non-survivors but did not reach statistical significance (p = 0.06).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate Predictors of Mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate logistic regression analysis is shown in Table 4. Elevated serum creatinine \u0026gt;1.4 mg/dL was present in all non-survivors and was strongly associated with mortality (OR 25.2, 95% CI 2.19\u0026ndash;290.23; p = 0.0003). Altered sensorium (OR 14.63, 95% CI 1.34\u0026ndash;159.23; p = 0.026) and shock (OR 14.67, 95% CI 1.50\u0026ndash;143.74; p = 0.041) were also significantly associated with mortality, demonstrating strong positive associations despite wide confidence intervals due to the small number of outcome events.\u003c/p\u003e\n\u003cp\u003eDialysis requirement showed a trend toward higher mortality but did not reach statistical significance (OR 10.75, 95% CI 1.18\u0026ndash;98.15; p = 0.06). Although AST and ALT levels were higher among non-survivors, they were not significantly associated with mortality in univariate regression analysis. Respiratory distress was also not significantly associated with mortality. (Table 4)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this 10-year retrospective cohort of patients with GlySH poisoning, shock, altered sensorium, and early renal dysfunction emerged as the strongest clinical predictors of in-hospital mortality. The primary objective of this study was to identify clinical and biochemical predictors of adverse outcomes in patients with GlySH poisoning presenting to a tertiary-care centre in South India. With the escalating global use of glyphosate-based herbicides and the corresponding rise in reported toxicity, understanding the clinical spectrum and prognostic indicators of GlySH poisoning remains highly relevant for both clinical management and public health interventions. Our findings reaffirm that although most patients recover with supportive therapy, mortality is closely associated with markers of multiorgan dysfunction\u0026mdash;particularly shock, altered sensorium, renal impairment, and hepatic injury.\u003c/p\u003e \u003cp\u003eThis study recorded a demographic profile of young adults between 25 and 44 years of age, mostly males, and frequently working in agricultural settings. This phenomenon has been documented in both domestic and international studies, where increased exposure risk is described as a consequence of occupational exposure. The occurrence of poisoning among students and the non-agricultural population shows that GlySH ingestion is not solely occupational but also due to the easy accessibility of the substance at home. Large Asian cohorts have shown similar trends, including the Korean study by Seok et al. that found intentional ingestion to be the most common means of exposure, highlighting the role of formulation toxicity in adverse outcomes. (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) These outcomes highlight the importance of community education, better access to mental health care, and the need for regulatory control of the pesticide trade as a means of preventing poisoning. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn contrast to some cohorts, age and sex were not significant predictors of mortality in our study. This is likely due to the limited number of deaths (n\u0026thinsp;=\u0026thinsp;4), which constrains the statistical power to detect demographic associations. The high prevalence of suicidal intent, observed in nearly two-thirds of patients in our study, is similar to global reports identifying GlySH Poisoning as a common means of attempted self-poisoning due to their widespread availability and perceived lethality. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe clinical spectrum of GlySH poisoning in our cohort was heterogeneous and included mainly gastrointestinal manifestations but also atypical presentations such as altered sensorium and excessive salivation. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) Fever was significantly more pronounced in non-survivors. Although this observation is based on a small number of events, it has been documented for severe pesticide poisonings and may represent an early systemic inflammatory response, infection due to aspiration, or developing sepsis in patients with high-grade toxicity, and it is an observation that requires further studies in larger prospective cohorts.\u003c/p\u003e \u003cp\u003eLaboratory abnormalities provided important insights into the pathophysiology of severe GlySH toxicity. Hypoalbuminemia and reduced total protein suggest systemic inflammation and capillary leaks, while renal dysfunction reflects disease severity. Although liver enzyme levels were higher among non-survivors, these differences were not statistically significant in our cohort. This is consistent with previous studies showing that surfactant-rich formulations cause direct mucosal and cellular injury, leading to fluid losses, vasoplegia, renal hypoperfusion, and hepatic dysfunction. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) As seen in the reports from the Korean and Sri Lankan cohorts, renal dysfunction was a prominent feature associated with mortality, underscoring the prognostic importance of early kidney injury in this setting. Importantly, the variables identified as predictors in this study -shock, altered sensorium, and elevated creatinine- should be interpreted as markers of advanced systemic toxicity rather than independent causal determinants of death. Given the retrospective design and sparse number of events, these findings indicate a late stage in the trajectory of multiorgan failure rather than modifiable risk factors. Accordingly, our data do not support causal inferences regarding the effect of specific interventions on survival. Instead, they highlight the need for prompt recognition of hemodynamic instability and renal impairment as indicators of high-risk disease requiring close monitoring and aggressive supportive care.\u003c/p\u003e \u003cp\u003eAnalysis of treatment patterns in this cohort highlighted that most patients improved with conservative management, illustrating the value of supportive therapy with mild to moderate poisoning. However, the subset of patients requiring mechanical ventilation and renal replacement therapy underscores the marked heterogeneity in clinical severity. Our results, along with the EXTRIP recommendations, reinforce the principle that hemodialysis, when done, should be prescribed based on the usual metabolic criteria (i.e., refractory acidosis, hyperkalemia, and oliguric acute kidney injury) rather than for the purpose of toxin removal.\u003c/p\u003e \u003cp\u003eIn summary, this study demonstrates that most patients with GlySH poisoning can be managed with supportive care measures, and mortality is closely associated with patients with shock, altered sensorium, and early renal dysfunction, reflecting advanced multiorgan involvement. Further, larger multicentric prospective studies with formulation-specific data are needed to validate these findings and develop standardized risk-stratification tools for clinical practice.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several important limitations, most of which relate to its retrospective design. Incomplete or inconsistent medical records may have resulted in information bias, with potential underreporting or misclassification of key variables such as ingested volume, time to presentation, and laboratory parameters.\u003c/p\u003e \u003cp\u003eSelection and spectrum bias are also likely, as our cohort may overrepresent more severe cases presenting to a tertiary-care centre, while patients with mild symptoms who did not seek hospital evaluation were not captured. Consequently, the clinical spectrum and mortality estimates may not fully reflect community-level exposure patterns. Establishing prospective regional registries with standardized data collection and follow-up would help capture the full range of disease severity in future studies.\u003c/p\u003e \u003cp\u003eThe small number of outcome events (n\u0026thinsp;=\u0026thinsp;4 deaths) substantially limited statistical power, precluded multivariable modelling, and resulted in wide confidence intervals around several effect estimates. All associations should therefore be interpreted as exploratory and hypothesis-generating rather than definitive.\u003c/p\u003e \u003cp\u003eResidual confounding is likely, as important factors such as exact ingested dose, formulation composition, baseline renal function, co-morbidities, and delays in treatment could not be fully accounted for. In addition, only short-term in-hospital outcomes were assessed; potential long-term sequelae involving renal, hepatic, or neurological function were not evaluated and require prospective follow-up.\u003c/p\u003e \u003cp\u003eThe single-centre design further limits the generalizability of our findings to other regions where glyphosate formulations, patterns of exposure, and access to healthcare may differ. Finally, laboratory confirmation and quantitative measurement of glyphosate were unavailable, precluding formulation-specific analyses and dose\u0026ndash;response assessment. These limitations underscore the need for cautious interpretation and external validation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis 10-year cohort study demonstrates that although most patients with GlySH poisoning recover with supportive care, in-hospital mortality is closely associated with shock, altered sensorium, and early renal dysfunction, reflecting advanced multiorgan involvement. These readily identifiable clinical and biochemical features may assist in early risk stratification and triage of high-risk patients in the emergency and resource-limited settings.\u003c/p\u003e \u003cp\u003eGiven the small number of outcome events and the retrospective design, these findings should be interpreted as hypothesis-generating rather than definitive. Larger, multicentric prospective studies with formulation-specific toxicological data are required to validate these predictors and to develop standardized risk-stratification tools for clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePresentation(s) or Awards at a meeting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work has not been presented at any meetings nor published as an abstract\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource(s) of Support and Funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report that no external funding or support was received for this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from the Institutional Research Board (IRB)/Institutional Ethics Committee, with registration numbers ECR/146/Inst/KA/2013/RR-16 and IEC: 179/2019, dated 7th August 2019.\u003c/p\u003e\n\u003cp\u003eThis study was conducted retrospectively using de-identified patient data. The requirement for informed consent was waived by the Institutional Ethics Committee due to the retrospective nature of the study. Confidentiality of patient information was strictly maintained\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.A.K., V.G., and S.N.S. contributed to the conceptualization, study design, and methodology development.\u003c/p\u003e\n\u003cp\u003eS.A.K., B.P.R., and S.S. performed data collection and data entry.\u003c/p\u003e\n\u003cp\u003eS.A.K., A.A.R., and S.S. conducted data curation and validation.\u003c/p\u003e\n\u003cp\u003eS.A.K. and A.A.R. performed formal data analysis and statistical interpretation.\u003c/p\u003e\n\u003cp\u003eS.A.K. and A.A.R. wrote the main manuscript text and prepared the tables and figures.\u003c/p\u003e\n\u003cp\u003eS.A.K., V.G., S.N.S., B.P.R., and S.S. contributed to critical revision of the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eS.A.K., V.G., and S.N.S. provided supervision and overall project oversight.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted retrospectively using de-identified patient data from hospital records. As such, obtaining informed consent from participants was not feasible. However, all ethical guidelines were strictly followed, and the study received approval from the Institutional Ethics Committee. Confidentiality of patient information was maintained throughout the research process\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Department of Emergency Medicine and the Medical Records Department for their support in facilitating data retrieval for this study. The authors did not receive any professional writing or editorial assistance in the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSeok SJ, Park JS, Hong JR, Gil HW, Yang JO, Lee EY, et al. Surfactant volume is an essential element in human toxicity in acute glyphosate herbicide intoxication. 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In Wiley Online Library; 2014. p. 362\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eEvans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063\u0026ndash;143. \u003c/li\u003e\n\u003cli\u003eAmerican College of Emergency Physicians. Clinical policy for the initial approach to patients presenting with altered mental status. Ann Emerg Med. 1999;33(2):251\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eZuercher M, Ummenhofer W, Baltussen A, Walder B. The use of Glasgow Coma Scale in injury assessment: a critical review. Brain Inj. 2009;23(5):371\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eDisease K. Improving global outcomes (KDIGO) acute kidney injury work group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1\u0026ndash;138. \u003c/li\u003e\n\u003cli\u003eCha ES, Khang YH, Lee WJ. Mortality from and incidence of pesticide poisoning in South Korea: findings from National Death and Health Utilization Data between 2006 and 2010. PLoS One. 2014;9(4):e95299. \u003c/li\u003e\n\u003cli\u003eKamaruzaman NA, Leong YH, Jaafar MH, Khan HRM, Rani NAA, Razali MF, et al. Epidemiology and risk factors of pesticide poisoning in Malaysia: a retrospective analysis by the National Poison Centre (NPC) from 2006 to 2015. BMJ Open. 2020;10(6):e036048. \u003c/li\u003e\n\u003cli\u003eVan Der Hoek W, Konradsen F. Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health. 2005;10(6):589\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eBanerjee I, Tripathi S, Roy AS, Sengupta P. Pesticide use pattern among farmers in a rural district of West Bengal, India. Journal of natural science, biology, and medicine. 2014;5(2):313. \u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;nez Caballero MA, Rodr\u0026iacute;guez JL, L\u0026oacute;pez Torres B, Mart\u0026iacute;nez Caballero M, Mart\u0026iacute;nez Larra\u0026ntilde;aga MR, Maximiliano Guerra JE, et al. Use of human neuroblastoma SH-SY5Y cells to evaluate glyphosate-induced effects on oxidative stress, neuronal development and cell death signaling pathways. 2020; \u003c/li\u003e\n\u003cli\u003eRoberts DM, Buckley NA, Mohamed F, Eddleston M, Goldstein DA, Mehrsheikh A, et al. A prospective observational study of the clinical toxicology of glyphosate-containing herbicides in adults with acute self-poisoning. Clin Toxicol. 2010;48(2):129\u0026ndash;36.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Demographic characteristics of GlySH poisoning\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%), n=51\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e15-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e20 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e25-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e23 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e45-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e6 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e65+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e39 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e12 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eAgriculture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e15 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e10 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eLaborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e8 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e4 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e14 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e36 (70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e15 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntent of Exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eSuicidal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e32 (62.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eStress-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e8 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e9 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIngested Amount (volumetric units)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eA spoon (5 mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e8 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eA mouthful (25 mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e10 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eA cup (100 mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e20 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eA bottle (300 mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e6 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eMissing data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e7 (13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElapsed Time (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e\u0026lt;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e16 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e7-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e17 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003e\u0026gt; 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e10 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eMissing data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e8 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical manifestation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e35 (68.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e36 (70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eDiarrhoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e5 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eAbdominal Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e11 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eSore throat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e7 (13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eDysphagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eHematemesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e3 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eOral ulcers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eAltered sensorium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e11 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eExcessive salivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eChest pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e3 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eSyncope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e2 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Modality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003ePrehospital treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e34 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eGastric Lavage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e41 (80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eActivated Charcoal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e4 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eConservative management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e45 (88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eMechanical Ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e5 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.416%;\"\u003e\n \u003cp\u003eDialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.584%;\"\u003e\n \u003cp\u003e6 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation: GlySH, Glyphosate-surfactant herbicide; mL, Milliliter\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Clinical characteristics and outcomes in patients with GlySH toxicity: A comparative analysis of survivors and non-survivors\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors (n = 47)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased (n = 4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n = 51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFisher\u0026rsquo;s Exact p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAge in years (Median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e34.5 (19.5-34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e44.5 (34.5-54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e34.5 (19.5-34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eGender Distribution (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e36/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e3/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e39/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003ePre-hospital Treatment (Yes/No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e33/14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e1/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e34/17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAbdominal Pain, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNausea/Vomiting, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e43 (91.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e4 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e47 (92.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFever, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention/Complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMechanical Ventilation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e1 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDialysis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e4 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e6 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eShock, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAltered Sensorium, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e3 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRespiratory Distress, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e8 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e10 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSuicide Attempt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e28 (59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e4 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e32 (62.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation: GlySH, Glyphosate-surfactant herbicide; IQR,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eInterquartile range.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Comparison of initial haematological and biochemical parameters between survivors and deceased patients in GlySH Toxicity\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors, n = 47, Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased, n = 4, Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematological Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHaemoglobin (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.2 (13.5\u0026ndash;14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.1 (13.5\u0026ndash;14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWBC Count (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.1 (11.3\u0026ndash;13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.1 (12.7\u0026ndash;13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePlatelet Count (10\u0026sup3;/mm\u0026sup3;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e259 (248\u0026ndash;269)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e259 (256\u0026ndash;263)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiochemical Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal Bilirubin (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6 (0.4\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7 (1.1\u0026ndash;4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDirect Bilirubin (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2 (0.2\u0026ndash;0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.4\u0026ndash;2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlbumin (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5 (4.2\u0026ndash;4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.9 (3.3\u0026ndash;4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal Protein (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.3 (6.8\u0026ndash;7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.4 (5.7\u0026ndash;6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAST (IU/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (28\u0026ndash;53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (34\u0026ndash;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eALT (IU/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (18\u0026ndash;44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (33\u0026ndash;61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eALP (IU/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76 (59\u0026ndash;103)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80 (62\u0026ndash;108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eElectrolytes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSodium (mEq/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e139 (136\u0026ndash;142)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e137 (135\u0026ndash;139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePotassium (mEq/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.2 (3.9\u0026ndash;4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.9 (4.3\u0026ndash;5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: GlySH, Glyphosate-surfactant herbicide; IQR, Interquartile range; g/dL, grams per deciliter; WBC, white blood cell count; mg/dL, milligrams per deciliter; U/L, Units Per Liter; mmol/L, Millimoles per liter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Predictors of mortality and clinical outcomes in GlySH Poisoning\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors, n/N (N = 47)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased, n/N (N = 4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, n/N, (%) (N = 51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated Creatinine (\u0026gt;1.4mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e8 (8/51, 15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e25.2 (2.19 - 290.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated AST (\u0026gt;40 IU)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e25 (25/51, 49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.41 (0.333 - 35.030)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElevated ALT (\u0026gt;42 IU)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e9/51, (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.71 (0.60 \u0026ndash; 54.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDialysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6/51 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.75 (1.18 \u0026ndash; 98.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eShock\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5/51 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14.67 (1.50 \u0026ndash; 143.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAltered Sensorium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e11/51 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14.63 (1.34 \u0026ndash; 159.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespiratory Distress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e10/51 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.88 (0.49 \u0026ndash; 48.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: GlySH, Glyphosate-surfactant herbicide; mg/dL, milligrams per deciliter; U/L, Units Per Liter; mmol/L.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Glyphosate, herbicide poisoning, mortality predictors, acute kidney injury, retrospective study, India","lastPublishedDoi":"10.21203/rs.3.rs-9260842/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9260842/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlyphosate–surfactant herbicide (GlySH) poisoning is increasingly reported in low- and middle-income countries, yet data on clinical predictors of mortality remain limited, particularly from the Indian subcontinent. This study aimed to describe the clinical profile of GlySH poisoning and to identify predictors of in-hospital mortality in a tertiary-care setting in South India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective observational study of consecutive adult patients with confirmed oral GlySH ingestion presenting to a tertiary-care emergency department between January 2009 and July 2019. Demographic, clinical, and laboratory variables were extracted from electronic medical records. In-hospital mortality was the primary outcome. Associations between clinical variables and mortality were assessed using univariate logistic regression and Fisher’s exact test, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Multivariable analysis was not performed due to the small number of outcome events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 51 patients were included, of whom four (7.8%) died. Most patients were young adults (45.1% aged 25–44 years), male (76.5%), and had suicidal intent (62.7%). In univariate analysis, shock (OR 14.67, 95% CI 1.50–143.74), altered sensorium (OR 14.63, 95% CI 1.34–159.23), and elevated serum creatinine \u0026gt;1.4 mg/dL (OR 25.2, 95% CI 2.19–290.23) were strongly associated with in-hospital mortality. Dialysis requirement showed a non-significant trend toward higher mortality, whereas liver transaminases and respiratory distress were not significantly associated with mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this 10-year cohort, mortality following GlySH poisoning was closely associated with shock, altered sensorium, and early renal dysfunction, reflecting advanced systemic involvement. These readily identifiable features may assist in risk stratification and triage of high-risk patients in the emergency setting. Given the small number of outcome events, these findings should be interpreted as hypothesis-generating, and larger multicentric prospective studies are required to validate these predictors.\u003c/p\u003e","manuscriptTitle":"A Decade of Glyphosate–Surfactant Poisoning in India: Clinical Patterns and Predictors of Mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 06:16:33","doi":"10.21203/rs.3.rs-9260842/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-14T14:14:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T16:42:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6870058254536155818551432122666899671","date":"2026-05-01T19:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110160775457790978433617112616127880679","date":"2026-04-30T05:47:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115436382729343007170526009050721868655","date":"2026-04-29T22:14:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T06:54:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43319980846520752191618374264148762438","date":"2026-04-21T12:24:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71031956166434566917478495818737657222","date":"2026-04-21T11:26:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T10:31:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T08:15:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T07:12:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-31T07:11:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2026-03-29T20:10:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2b53da06-3226-4bbe-a2ea-9c3447c3b21d","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-14T14:14:23+00:00","index":66,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T16:42:52+00:00","index":65,"fulltext":""},{"type":"reviewerAgreed","content":"6870058254536155818551432122666899671","date":"2026-05-01T19:33:55+00:00","index":63,"fulltext":""},{"type":"reviewerAgreed","content":"110160775457790978433617112616127880679","date":"2026-04-30T05:47:45+00:00","index":60,"fulltext":""},{"type":"reviewerAgreed","content":"115436382729343007170526009050721868655","date":"2026-04-29T22:14:24+00:00","index":59,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T06:16:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 06:16:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9260842","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9260842","identity":"rs-9260842","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}