Project for Epidemiological Monitoring and Handling Complaints Regarding the Toxic Effects of the Mixture Used for Aerial Spraying for the Purpose of Destroying Illicit Crops in the Republic of Colombia
Report on the Investigation of the Case of the Death of a Person Exposed to Spraying Using a Glyphosate Mixture
By Jorge Hern�n Botero Tob�n, M.D.
Chemical Risks, Human Health and Environment Consultant
Bogota, D. C. July 4, 2003
In the case of the sole agent used, N-phosphone-methylglycine or Glyphosate, there is a complete set of basic scientific research that supports its low toxicity for human beings, animals, and environmental tracer species, in addition to its benevolent behavior regarding the abiotic environment. Also, numerous scientific papers have discarded the presence of undesirable properties regarding its effect on ecosystems and on the environment.
At any rate, monitoring the possible risk involved in the illicit crop eradication activity contributes to improving its real image and to distinguishing possible non-described or non-documented effects of the substance, in the context of the conditions under which it is applied.
The purpose of this report is to provide the technical elements and the scientific proof for the analysis of the possible lethal effect of Glyphosate spraying for the purpose of destroying illicit crops on a person in the settlement Las Pavas or Aguas Lindas in the municipality of San Pablo in the South of the Provincial Department of Bol�var.
On July 3, 2003, a lunchtime TV news program spoke of a man who died from exposure to the Glyphosate mixture sprayed over an illicit crop field.
The only details that the information included were that the man died in Bucaramanga after having been remitted to the hospital there from the hospital in the Municipality of San Pablo (Provincial Department of Bol�var).
On July 3 at 6:10 p.m. I traveled to the city of Bucaramanga, arriving at 7:00 p.m.. That same evening I interviewed Anti-narcotics Police personnel and obtained some preliminary details, such as the name of the deceased, the time he had been attended, and the impressions of the Assistant Science Director of Hospital Universitario Ram�n Gonz�lez Valencia (University Hospital Ram�n Gonz�lez Valencia). He thought that the man's death could have been due more to an infection than to intoxication and that he would have more information once an autopsy was done.
So I prepared a work plan for Friday, July 4. I would start out with a visit to the hospital to obtain the clinical file data or at least a more complete version of what had occurred because, in a case such as this one, both the clinical history and all related data become a part of the reserved abstract of the criminal investigation initiated when there is suspicion that death may have been caused by intoxication.
My agenda would continue with an attempt to contact the deceased's widow for the purpose of gathering clinical and epidemiological data that could help to clarify the causes of the deceased's illness and later death. I missed her by just a few hours as she had gone back to the deceased's village of birth at 3:00 a.m. that day.
Finally, I would visit the regional office of the Legal Medicine and Forensic Sciences Institute to obtain information on what was discovered in the autopsy.
CLINICAL FILE DATA
At Hospital Universitario Ram�n Gonz�lez Valencia, Assistant Science Director Doctor �ngel Mart�n Jim�nez Rueda attended me. He gave me unlimited access to the clinical files, from which I gathered the following data:
Patient Pedro Elviro Mat�as D�az, identified by Colombian Citizen Card No. 92.258.583, was a resident of the settlement Aguas Lindas in the Municipality of San Pablo (Provincial Department of Bol�var), born in Sampu�s (Provincial Department of Sucre).
The patient fell ill on June 25, 2003. His symptoms were a very intense headache, vomiting and a fever and his state of consciousness was progressively deteriorating. As he could not speak or eat, he was taken to the San Pablo local hospital on June 30, 2003 where he arrived dehydrated and in a generally bad condition. He was fed liquids and analgesics intravenously.
Lab tests were done with the following results:
Blood Workup: Hemoglobin: 14 g/L; Hematocrit: 45%; Leukocytes: 13,200/mm3; Neutrophils: 80%; and Lymphocytes: 20%.
Blood Chemistry: Glycemia: 72 mg/dL; Uric Nitrogen: None; Creatinine: 0.93 mg/dL.
Given the fact that his condition kept worsening and that his dehydrated condition could not be compensated, the decision was made to remit him to the hospital in Bucaramanga on July 2, 2003. He arrived there at 1:15 p.m..
The clinical files show data similar to the data at the first hospital. In the background information, his spouse stated that, while her husband was working in a coca field, an airplane flew overhead and sprayed the field and that ten days after the symptoms described above started.
The physical exam made when he was admitted into this hospital showed that the patient was in a generally bad condition and that he had marked hypersecretion of saliva, contracted pupils with little reaction to light, no response to stimuli, and he was pale.
He presented veiled heart murmur, general difficulty in breathing, multiple pulmonary respiratory murmurs due to excessive secretions in the respiratory tracts, rale in both lungs, and profound depression of his state of consciousness (3 on the Glasgow scale of 15).
He was admitted with possible diagnoses of organophosphate intoxication, meningitis, and third-degree dehydration.
He was given liquids intravenously: Normal Saline Solution (0.9%), 1,600 mL / hour, atropine 24 ampules every 2 hours and tests for cholinesterase and organophosphate and carbamate in urine were ordered.
The lab tests showed:
Blood Workup: Hemoglobin: 15.8 g/L; Hematocrit: 46%; Leukocytes: 5,000/mm3; Neutrophils: Segmented 78%; Lymphocytes: 13% and 9% banded cells.
Blood Chemistry: Glycemia: 122 mg/dL; Uric Nitrogen: 75.5 mg/dL (Reference Value 4.67 to 23.4 mg/dL); Creatinine: 2.60 mg/dL (Normal up to 1 mg/dL).
In spite of the treatment initiated, the patient died two hours later, without responding to reanimation efforts.
I interviewed Doctor M�nica Villegas, an Internal Medicine Specialist, who had attended the case in the Hospital Gonz�lez Valencia Emergency Room. She agreed that, in addition to the above, the patient was suffering from obvious acute renal failure and that the patient's history and the clinical findings when he was admitted were compatible with a central nervous system infection or an intoxication due to a cholinesterase, organophosphate or carbamate inhibitor agent.
At the Legal Medicine and Forensic Sciences Institute in Bucaramanga, the Institute Medical Coordinator Doctor Luis Fernando Mar�n Orteg�n and Doctor Dar�o Useche who had done the necropsy attended me. They informed me that the necropsy had been performed on the afternoon of the death and that they had observed general signs of multiple-organ failure, indicated by generalized visceral congestion and marked cerebral edema, but no signs of a central nervous system acute bacterial infection. They found nothing else that could specifically indicate the cause of death.
Samples were taken of all of the organs and they were sent to the Legal Medicine and Forensic Sciences Institute in Bogota in duplicate samples.
CLINICAL HISTORY ANALYSIS
In this case, we can observe a reference to direct exposure to a Glyphosate mixture used for spraying, ten days before the appearance of the symptoms that finally led to the patient's death.
Let's evaluate the exposure. Conservatively speaking, considering a body surface of 1.73 m2 for an adult man, the dose received on the surface of the skin would be:
1.73 m2  X 3,740 mg/m2 of Glyphosate = 6,470.2 mg
According to the literature available on the topic, this is not a toxic or lethal level for a Glyphosate dose absorbed in the skin because the mortality associated with exposure has solely been observed after ingesting great quantities (more than 150 mL of the commercial formula that has a concentration of 480 mg of Glyphosate per liter, that is to say, some 72 grams.
The dose of exposure in this case would be equal to the quantity of 13 mL. As it is less than the 50 mL mentioned in the literature available on the topic, it would not cause any effect if orally ingested. Glyphosate absorbed through oral ingestion is much greater (36% of the administered dose) than when absorbed through the skin (2 to 5%),.
 Botero J. H., ICEP Assessment, Roundup � Exposure Risk Panorama in the ICEP, Narcotics Affairs Section, U.S. Embassy, July 2000.
 Environmental Health Criteria No. 159, Glyphosate, International Programme on Chemical Safety, World Health Organization, Geneva, 1994.
 Williams, G. M.; Kroes, R; Munro, I. C.; Safety Evaluation and Risk Assessment of the Herbicide Roundup �, J Regulatory Toxicology and Pharmacology, 31: 117-165, Academic Press, 2000.
The patient's symptoms suggest the specifics of a central nervous system infectious disease, such as incipient meningitis, due to the presence of fever with cephalea and the progressive deterioration of the state of consciousness. This would also concur with the fact that great cerebral edema was found in the autopsy, which, as there was no pus present, would incline us toward a hypothetical diagnostic of a disease of a viral origin.
However, the signs of intensely contracted pupils with scarce response to light and the exaggerated secretion of saliva greatly suggest intoxication of a cholinesterase-inhibitor chemical substance, such as organophosphate and carbamate pesticides, frequently used to protect coca crops against various pests. These pesticides can be absorbed through the skin if a person enters a recently treated field or if a person applies them using a pump spraying device on his back.
Also, upon reviewing the treatment given at the hospital, it is obvious that the patient was fed endovenous liquids sufficient in quantity and in sodium content to replace the losses suffered. He also received an efficacious antidote against a cholinesterase-inhibitor poison intoxication. However, the progressive deterioration of his general condition and a marked hydro-electrical imbalance finally led to a multiple-organ failure and to the patient's death.
It is possible that the microscope and chemical tests of the samples of the organs taken during the necropsy could contribute conclusive data on the cause of death. Because although we are certain that the death cannot be attributed to exposure to Glyphosate, we cannot yet explain the cause of death in a conclusive, complete manner.
Lastly, for this case, it would be very important to also verify the exposure. It should be verified against the spraying records for that date, to check the day and the time of the alleged spraying of the field in which the man in this report was allegedly exposed.