Introduction: Herbicidal compounds are one of the common types of poisonings used for Deliberate Self Harm in Developing countries, associated with high morbidity and mortality with multisystem toxicity The rare manifestations involve Cardiovascular and Neurological system.
Case Report: In 2025, a 30-year-old male presented to emergency department at Lata Mangeshkar hospital, India, one hour after ingestion of 150 ml of 41% glyphosate (Glycel) with vomiting, tachycardia (140/min), hypotension and hypoxia. Within hours, he developed metabolic acidosis, type 1 respiratory failure, refractory hypotension requiring noradrenaline, left ventricular dysfunction (EF 35%), and neurological signs (horizontal/vertical nystagmus, diplopia). Management included gastric lavage, mechanical ventilation, Inotropic support (Noradrenaline, Dobutamine), N-Acetylcysteine and Antibiotics for aspiration pneumonia. MRI Brain was normal. By day 6, cardiac, neurological and respiratory parameters gradually normalized; the patient was extubated and discharged without sequelae after psychiatric evaluation.
Discussion: The severe multisystem toxicity observed in this case, particularly the transient cardiomyopathy and neurological deficits, is primarily driven by the surfactants in commercial glyphosate formulations rather than the glyphosate moiety itself. These surfactants likely induce cellular damage through mitochondrial dysfunction and the uncoupling of oxidative phosphorylation. The reversibility of these manifestations suggests a transient toxic-metabolic process rather than permanent structural injury, emphasizing the critical role of surfactant-induced cardiotoxicity and neurotoxicity.
Conclusion: This case highlights rare cardiovascular and reversible neurotoxic effects of glyphosate poisoning which is mainly due to mechanism of uncoupling of oxidative phosphorylation. The most common clinical symptoms are gastrointestinal like erosions and gastrointestinal hemorrhages. Increased risk of mortality is seen patients developing acute kidney injury, pulmonary edema and hyperkalemia. This case report underscores the efficacy of aggressive supportive care in achieving favorable outcomes despite absence of an antidote.