Acetaminophen overdose followed by ingestion of an herbicide: A case of unique combination

Drug overdose and herbicide consumption are two common methods that are widely used for self-destruction. This article presents a unique case of self-poisoning by ingestion of Acetaminophen (Paracetamol) followed by herbicide 2-Methyl-4-chlorophenoxyacetic Acid (MCPA). No such a case has been reported in the literature. A 53-year-old male was admitted vomiting and semi-conscious, with a history of ingestion of MCPA. He was treated with gastric lavage, activated charcoal, sodium bicarbonate, intravenous fluids and, antibiotics. He succumbed despite mechanical ventilation. Death investigation revealed fatal toxicity with MCPA and acetaminophen with the possible manner of death being stated as complex suicide. This case highlights the importance of considering the ingestion of a second poison by clinicians and forensic pathologists when response to the appropriate management of a specific poison is poor.