TY - JOUR ID - 14808 TI - Substituted Urea Herbicide (Diuron) Induced Haemolytic Anemia: A Case of Unknown Complication in Humans JO - Asia Pacific Journal of Medical Toxicology JA - APJMT LA - en SN - 2322-2611 AU - Weerasinghe, Suneth AU - Gawarammana, Indika AU - Colambage, Anuradha AD - Teaching Hospital, Peradeniya, Sri Lanka. AD - Consultant Physician (Professorial Medical Unit, Teaching Hospital Peradeniya), Senior Lecturer in Clinical Toxicology Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka AD - Consultant Physician (Acting), Teaching Hospital Peradeniya, Sri Lanka. Y1 - 2019 PY - 2019 VL - 8 IS - 4 SP - 134 EP - 139 KW - Diuron KW - Haemolytic Anemia KW - G6PD deficiency KW - Methemoglobinemia KW - Substituted Urea Herbicide DO - 10.22038/apjmt.2019.14808 N2 - Background: Substituted urea herbicide is widely used in the agricultural industry and is accessible to most people around the globe. Accidental or deliberate poisoning is an anticipated complication of these agrochemical products. Case presentation: We present a 15-year-old girl following deliberate self-ingestion of substituted urea herbicide (Diuron). She was diagnosed with Diuron induced methemoglobinemia and treated with intra venous methylene blue. Later she developed hemolytic anemia and needed 3 units of blood transfusions. Her haemolysis was thought to be due to methylene blue with concomitant Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency as no other possible cause was found for haemolysis. But on follow-up visits, G6PD deficiency was excluded by screening test and enzyme level assay. Conclusion: Heamolytic anemia is a possible rare complication that should be anticipated in patients presented with the significant amount of substituted urea herbicide poisoning. Studies have found the possibility of reactive oxygen species accumulation in cells leading to oxidative damage. But we were unable to find any reported cases of haemolysis in humans. We postulate that the inhibition of NADPH production like G6PD deficiency may be the key mechanism that causes haemolysis in humans by creating an acquired G6PD deficiency status in red blood cells. However, further studies are needed to identify the exact mechanism of hemolysis in humans. UR - https://apjmt.mums.ac.ir/article_14808.html L1 - https://apjmt.mums.ac.ir/article_14808_e2bef57fbe3d00b3041822352954a8e4.pdf ER -