DOI: http://dx.doi.org/10.18203/2349-3933.ijam20182464

Clinical spectrum and outcome of paraquat poisoning in a tertiary care teaching hospital

Halesha B. R., Venugopal K.

Abstract


Background: Paraquat is most common insecticide compound used for suicidal consumption in rural part of the Karnataka next to organo-phosphorous compound. It produces various local and systemic manifestations in the early course. It is very notorious to cause multi-organ dysfunction and mortality within 24 hours in severe amount of consumption. Lack of specific antidote and high-quality evidence based medicine makes the management of paraquat poisoning challenging. Hence, we took up the study to evaluate the clinical features, course and management option for the poisoning.

Methods: It is an observational study conducted at HIMS, Hassan. History was collected from patient and bystanders. Clinical features, laboratory parameters were noted regularly and frequently. Patient’s complications were identified initially and treated accordingly. All the data collected were tabulated and statistically analysed.

Results: Out of 110 patients, 72 were females and 38 were males; most of them were in the age group of 30-40 years. Mild poisoning was noted in 30, moderate in 56 and 24 patients were severe. Most common symptom was nausea and signs were oral cavity ulcers followed by tachycardia and tachypnoea. The overall mortality was 72%, 18% were recovered fully and 10% patients left against medical advice.

Conclusions: Since there is a lack of antidote management of paraquat is challenging. Early gastric lavage, aggressive fluids, IV methyl prednisolone and N-Acetyl-Cysteine is beneficial.


Keywords


Acute renal failure, Free radicals, Multi-organ dysfunction, Paraquat, pulmonary fibrosis

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References


Giulivi C, Lavagno CC, Lucesoli F, Bermudez MJ, Boveris A. Lung damage in paraquat poisoning and hyperbaric oxygen exposure: superoxide-mediated inhibition of phospholipase A2. Free Radic Biol Med. 1995;18(2):203-13.

Shashibhushan J, Venugopal K, Lingaraja M, Patanjali CP, Suresh C, Huggi V. Paraquat: A fatal poison. Med J Dr. DY Patil Vidyapeeth. 2015;8(3):370.

Honore P, Hantson PH, Fauville JP, Peeters A, Mahieu P. Paraquat Poisoning: “State of the Art “. Acta Clini Belg. 1994;49(5):220-8.

Suntres ZE. Role of antioxidants in paraquat toxicity. Toxicol. 2002;180(1):65-77.

Jones GM, Vale JA. Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review. J Toxicol: Clini Toxicol. 2000;38(2):123-8.

Vale JA, Meredith TJ, Buckley BM. Paraquat poisoning: clinical features and immediate general management. Hum Toxicol. 1987;6(1):41-7.

Stephens BG, Moormeister SK. Homicidal poisoning by paraquat. Am J Forensic Med Pathol. 1997;18:33-9.

Hart TB, Nevitt A, Whitehead A. A new statistical approach to the prognostic significance of plasma paraquat concentrations. Lancet. 1984;324(8413):1222-3.

Wong OF, Fung HT, Kam CW. Case series of paraquat poisoning in Tuen Mun Hospital. Hong Kong J Emerg Med. 2006:13(3):155-60.

Afzali S, Gholyaf M. The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning. Arch Iran Med. 2008;11(4):387-91.

Agarwal R, Srinivas R, Aggarwal AN, Gupta D. Experience with paraquat poisoning in a respiratory intensive care unit in North India. Singapore Med J. 2006;47(12):1033-7.

Agarwal R, Srinivas R, Aggarwal AN, Gupta D. Immunosuppressive therapy in lung injury due to paraquat poisoning: a meta-analysis. Singapore Med J. 2007;48(11):1000.

Addo E, Poon-King T. Leucocyte suppression in treatment of 72 patients with paraquat poisoning. Lancet. 1986;327(8490):1117-20.

Perriens JH, Benimadho S, Lie Kiauw I, Wisse J, Chee H. High-dose cyclophosphamide and dexamethasone in paraquat poisoning: a prospective study. Hum Exp Toxicol. 1992;11(2):129-34.

Lin JL, Wei MC, Liu YC. Pulse therapy with cyclophosphamide and methylprednisolone in patients with moderate to severe paraquat poisoning: a preliminary report. Thorax. 1996;51(7):661-3.

Yoshida T, Tanaka M, Sotomatsu A, Okamoto K. Effect of methylprednisolone-pulse therapy on superoxide production of neutrophils. Neurol Res. 1999;21(5):509-11.

Fox DA, McCune WJ. Immunosuppressive drug therapy of systemic lupus erythematosus. Rheum Dis Clin North Am. 1994;20(1):265-99.

van der Wal NA, Smith LL, van Oirschot JF, van Asbeck BS. Effect of Iron Chelators on Paraquat Toxicity in Rats and Alveolar Type II Cells1-3. Am Rev Respir Dis. 1992;145:180-6.

Burton GW. Vitamin E: molecular and biological function. Proceedings of the Nutr Soc. 1994;53(2):251-62.

Drault JN, Baelen E, Mehdaoui H, Delord JM, Flament F. Massive paraquat poisoning. Favorable course after treatment with n-acetylcysteine and early hemodialysis. Ann Fr Anesth Reanim. 1999;18(5):534-7.

Moldeus P, Cotgreave IA, Berggren M. Lung protection by a thiol-containing antioxidant: N-acetylcysteine. Respiration. 1986;50(Suppl. 1):31-42.