Rapid Glomerulotubular Nephritis as an Initial Presentation of a Lethal Diquat Ingestion

Introduction. Diquat is an herbicide that can lead to rapid multiorgan system failure upon toxic ingestion. Although Diquat shares a similar chemical structure with paraquat, diquat is still readily available to the general population, and in contrast to paraquat, it is not regulated. We present a case of an intentional diquat poisoning which emphasizes the necessity of the early recognition due to atypical symptoms within the first 24 hours and certainly enhanced regulatory restrictions on this very toxic compound. Case. A 60-year-old male with a history of severe depression presented to the emergency department after intentional ingestion of a commercial herbicide containing diquat dibromide 2.30%. The earliest manifestations of this acute diquat intoxication comprised a glomerulonephritis and proximal tubular dysfunction. Progressive multiorgan system failure then developed with a significant delay (24–38 hours) including acute renal, liver failure, and then respiratory failure with refractory hypoxemia. Despite maximal supportive care, the end organ failure was lethal. Discussion. Diquat intoxication should be suspected in patient presenting an acute glomerulonephritis with coma. Diquat should undergo the same regulatory restrictions as paraquat-containing compounds.

Neurologic Emergencies

Neurologic emergencies may occur in children and generate a significant differential diagnosis of potentially life-threatening etiologies. This chapter reviews the most common and/or important neurological emergencies, including febrile seizures, first presentation of afebrile seizures, seizure variants, breakthrough seizures in epilepsy, seizures due to toxic ingestion, status epilepticus, altered mental status, headache, migraine syndromes, encephalitis, acute demyelinating encephalomyelitis, acute cerebellar ataxia, anti-NMDA receptor encephalitis, motor dysfunction/weakness syndromes such as Guillain-Barre syndrome, polyneuropathies, transverse myelitis, acute periodic paralysis, acute flaccid myelitis, and neuromuscular disorders such as botulism, myasthenia gravis. The common presentations, atypical presentations, evaluation, disposition, clinical pearls, and pitfalls of these important pediatric neurologic emergencies are discussed.