Forced alkaline diuresis as a therapeutic strategy for managing acute 2,4-D dimethylamine salt poisoning

BMJ Case Rep. 2026 Mar 31;19(3):e271984. doi: 10.1136/bcr-2026-271984.

ABSTRACT

We report the case of a woman in her 30s who presented with intentional ingestion of approximately 50 mL of the herbicide 2,4-D dimethylamine salt. The initial clinical picture included vomiting, haematemesis, hypotension and hypokalaemia. After stabilisation, the endoscopy conducted demonstrated Zargar Grade 2a oesophageal and Grade 1 gastric corrosive injuries. Despite ongoing fluid resuscitation and potassium repletion, she developed acute kidney injury and liver dysfunction. Hence, forced alkaline diuresis with intravenous sodium bicarbonate and furosemide was instituted, targeting urine pH >7.5 for 72 hours. Renal and hepatic parameters subsequently recovered without the need for haemodialysis. The patient was discharged on day 7 and remained asymptomatic on follow-up. Early recognition and mechanism-based therapy with forced alkaline diuresis, combined with vigilant monitoring and electrolyte correction, can be an effective, feasible alternative to extracorporeal removal in appropriately selected patients with 2,4-D dimethylamine salt poisoning.

PMID:41916699 | DOI:10.1136/bcr-2026-271984