Paraquat is a bipyridyl compound with no known chronic toxicity or teratogenicity. Toxicity has occurred after topical application, oral ingestion or inhalation of paraquat. General approaches to the assessment of the poisoned patient are discussed separately. Paraquat, a quarternary nitrogen herbicide, is a highly toxic compound for humans and animals and many cases of acute poisoning and death have been reported over the past few decades. The present case report introduced a 25yearold male with nausea, vomiting, and severe substernal burning sensation after incidentally ingestion of a large amount of paraquat. In humans, ingestion of pq is frequently fatal and is associated with a high mortality rate sabzghabaee et al. The very high case fatality of paraquat is due to inherent toxicity and lack of. Liquid technical products range from to concentration, but the formulations used in the. Within 1224 h after ingestion 90% of the absorbed paraquat is rapidly excreted unchanged in urine. Successful treatment of patients with paraquat intoxication.
Successful treatment of paraquat poisoning by xuebijing, an. Pulmonary fibrosis due to lipid peroxidation is a major symptom of paraquat intoxication. Serum paraquat nomograms correlate serum paraquat concentration with mortality risk the proudfoot nomogram, best cut off for the severity in paraquat poisoning sipp sipp score paraquat concentrationmgdl x time since poisoning hrsscore paraquat assay within a relevant. Ethane in the expired breath exeth reflects lipid peroxidation and may be a measure of the damage effected by oxygen radicals in acute lung injury. However, fullers earth or activated charcoal is an effective treatment, if taken in time. Paraquat generates reactive oxygen species which cause cellular damage via lipid peroxidation, activation. Paraquat present as paraquat dichloride 1910425 250 gl emulsifiers 10 30% other ingredients including water determined not to be hazardous balance section 4 first aid measures first aid. Paraquat and diquat 3dudtxdw dqg gltxdw duh lghqwl. Paraquats rapid action gives farmers confidence that weeds have been controlled and avoids the temptation to spray again. Chest computed tomography ct scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days after. In 2000, an 18monthold boy ingested an unknown amount of paraquat solution from a bottle found in his fathers landscaping truck.
Successful management of severe paraquat poisoning. Clinical features are largely due to intracellular effects. Paraquat is a highly toxic herbicide, which not only leads to acute organ damage, but also to pulmonary fibrosis. It was banned there in 2002 because of the unacceptable risk of adverse health effects, but industry pressure caused a reversal of the ban in 2006.
Jan 20, 2020 paraquat is a commonly available herbicide that is lethal in small quantities of. Poisoning by paraquat herbicide is a major medical problem in parts of asia while sporadic cases occur elsewhere. Despite noteworthy research and clinical efforts worldwide in the last few decades, little improvement has been made in reducing fatality from paraquat poisoning with conventional treatment strategies. Intravenous paraquat poisoning is rare and is strongly associated with attempted. It is rapidly distributed to lung, liver, kidney and muscle. Pdf a new treatment approach for acute paraquat poisoning. Paraquat toxicity and lipid peroxidation jama internal. History formulation, strength and dose are important 30ml of 20% paraquat can be lethal. Death may occur from a hole in the esophagus, or from severe inflammation of the area that surrounds the major blood vessels and airways in the middle of the chest. Both indian male and female appeared to be equally at risk. The toxic compound accumulates in lung tissue where free radicals are formed, lipid peroxidation is induced.
Paraquat may also damage the kidneys, liver, and esophagus the tube that food goes down from your mouth to your stomach. This has been the result of the development of a conjunctivalised corneal surface and chronic inflammation. The treatment of the patient with antioxidants nacetylcysteine and vitamin e and hemodialysis started immediately after arriving to. It points out that a ingestion of large amounts result in. Paraquat is a rapidlyacting, nonselective he it seems to us that you have your javascript disabled on your browser. It is poorly absorbed when inhaled, but causes severe illness when ingested orally, death usually occurring within 2 days of ingestion of 50 mgkg. However, there is not many published literature on studies done locally. Ventilator settings and outcome of respiratory failure in. Paraquat can be mixed easily with food, water, or other beverages. Mean interval time between paraquat ingestion to respiratory failure was 2. The most likely route of exposure to paraquat that would lead to poisoning is ingestion swallowing. When accidentally or intentionally ingested, paraquat is a multisystem poison capable of causing toxicity to the lungs, kidney, liver, brain, heart, and muscle. Extracorporeal therapies ectr have been practised in pq poisoning management, though limited evidence could be obtained to suggest its superiority over. Tissue concentration of paraquat on day 32 after intoxication.
The radical cation is also susceptible to further reduction to the neutral paraquat 0. Paraquat is an oxidant that interferes with electron transfer, a process that is common to all life. To report on three patients with paraquat pq intoxication surviving after combined therapy with hemoperfusion hp, cyclophosphamide ctx, and glucocorticoid. Acute diquat poisoning with intracerebral bleeding. Demographics, clinical presentation, and laboratory data were evaluated. There is as yet no successful treatment for this form of poisoning and efforts to diminish its lethal effect continue to be only partly. Bridging the time to complete depletion of paraquat from the body could render this exceptional therapy strategy possible, but not much is known. Although ventilator dependence has traditionally been regarded as a relative contraindication for lung transplantation, candidates who deteriorate while on a waiting list and patients who develop acute respiratory failure in the absence of any associated organ dysfunction represent.
Paraquat can be absorbed by the skin, espe cially if skin has been exposed to the chemical. If swallowed, burning of the mouth and throat often occurs, followed by gastrointestinal tract irritation, resulting in abdominal pain, loss of appetite, nausea, vomiting, and. Paraquat poisoning and colchicine treatment annals of. Main features in the treatment were removal of paraquat by gastric lavage, forced diuresis, hemodialysis, and charcoal hemoperfusion. Paraquat is a contact herbicide that is used worldwide due to its rapid inactivation in the environment 1. Paraquat ingestion is a leading cause of fatal poisoning in many parts of asia, pacific nations, and the americas. Toxicokinetics of paraquat upon ingestion, paraquat is rapidly but incompletely absorbed. Paraquat causes direct damage when it comes into contact with the lining of the mouth, stomach, or intestines. Three patients suffered acute renal failure in a few days after ingesting a lethal amount of pq. Treatment for pq poisoning in a timely manner is still a challenge for clinicians.
Who reports that risk is dependent on route of exposure as well as the dose, and that the target organs are lungs, kidneys, liver and myocardium. References paraquat is highly acutely toxic and enters the body mainly by swallowing, or through damaged skin, but may also be inhaled. Clinical features and prognosis of paraquat poisoning in fre. Paraquat is poorly absorbed about 5% to 10% from the intestinal tract. Survival in a case of massive paraquat ingestion chest. Efficacy of initial haemopurification strategy for. A case report of acute severe paraquat poisoning and long.
There are only anecdotal reports of rescue lung transplantation, as paraquat is stored and only slowly released from different tissues. A small amount of pq ingestion could be lethal, yet currently, the optimal treatment is still controversial. Chest computed tomography ct scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days. After 22 h the patient was admitted to hospital with serious liver, kidney and lung damage.
About 45% of the absorbed dose is excreted in the urine by 48 hours after ingestion. The lethal ingestion dose of paraquat in humans is 35 mgkg. Most of the indicators of poor prognosis were encountered in. Paraquat ingestion can result in early fatality due to multiorgan failure. Prospective, cohort study of patients admitted with. A urine paraquat measurement done on a specimen obtained days after ingestion revealed a level of 0.
Oral ingestion is the most common pathway of poisoning. Introduction paraquat pq is a widely used herbicide which is inexpensive and easily accessible for people in rural areas. Medical management and outcome of paraquat poisoning in ahvaz. Despite treatment, renal and respiratory failure progressed and he died 16 days after ingestion. Paraquat is a commonly available herbicide that is lethal in small quantities of. Thousands of deaths have occurred from ingestion often suicide or dermal exposure mainly. The boy survived in the hospital for days after the ingestion and received aggressive treatment but died after suffering acute kidney and liver failure.
In malaysia women sprayers can spray herbicides, commonly paraquat, 262 days of the year. Paraquat and aluminium phosphide are major problems in particular countries with extremely high fatality ratios of over 60%. Clinical implications of the ethane in exhaled breath in. If the form of paraquat that is used does not contain the safeguard additives dye, odor, and vomiting agent, people might not know that the food, water, or other beverages are.
Single lung transplantation for adult respiratory distress. The extent of poisoning caused by paraquat depends on the amount, route, and duration of exposure and the persons health condition at the time of the exposure. Documented cases of paraquat toxicity, although few, have noted a relatively mild initial appearance with a poor visual outcome in the long term. We report a case of suicidal paraquat ingestion in a 59yearold man. Paraquat poisoning, resulting in serious damage to various organs, may be caused by ingestion of just one teaspoon of paraquat. The purpose of this study was to evaluate the clinical efficacy of exeth as a measure of exposure to paraquat and as an indicator of lung damage. Ingestion of a large amount of paraquat is considered to be fatal. A study on paraquat poisoning in the state of perak in. This is a major concern to epa because paraquat is a restricted use pesticide that should not be. A case of paraquat poisoning was successfully treated which would have been considered lethal according to a reported prognostic index.
The treatment of the patient with antioxidants nacetylcysteine and vitamin e and hemodialysis started immediately after arriving to the hospital. The patient was successfully managed and made a complete recovery. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. In this paper special attention has been given to the major clinical differences between diquat and paraquat intoxication. Because of the severe lung and kidney involvement, it was suspected that the child had in fact ingested paraquat gramoxone.
A case of severe diquat poisoning complicated by the development of aggressive behaviour, oliguric renal failure, and intracerebral bleeding is described. A 41yearold male with no prior comorbidities presented to the emergency department with painful swallowing and reduced urine output 2. Paraquat pq is a widely used herbicide and it can cause pulmonary toxicity and even acute lung injury. Paraquat is a fast acting, potent, and nonselective contact herbicide. Paraquat poisoning paraquat toxicity %2f parquat lung. Pure paraquat ingested is highly toxic to mammals and humans potentially leading to acute respiratory distress syndrome ards, and there are no specific antidotes. Ingestion of paraquat results in an extremely dangerous poisoning. Paraquat is a substance that is highly poisonous to humans. Human and experimental toxicology of diquat poisoning. Serious exposure to the herbicide paraquat usually results in death, either due to gastrointestinal caustic lesions, shock, and acute respiratory distress syndrome or related to the progressive development of pulmonary fibrosis associated with refractory hypoxemia. Paraquat poisoning an overview sciencedirect topics. When accidentally or intentionally ingested, paraquat is a multisystem poison capable of causing toxicity to the lungs, kidney, liver, brain, heart, and. Kidney disease and age50yrs bad prognosis time of ingestion painful mouth, difficulty in swallowing, nausea, vomiting, abdominal pain burning skin sensation respiratory complaintssystemic poisoning.
Pq ion kg, patients develop acute renal failure, acute lung injury and progressive pulmonary fibrosis, with death occurring within. Hg fkhplfdoo\ dv gls\ulg\ov paraquat is a synthetic, nonselective contact herbicide, marketed as paraquat, paraquat dichloride salt and bismethylsulfate salt. Some paraquat is detected in the urine for 21 days after ingestion. Intentional and accidental ingestion of commercial liquid formulations of paraquat has caused a large number of human fatalities in taiwan 2. A clinical study of prognosis and glucocorticoid pulse. The ocular surface toxicity of paraquat british journal of. Chlorphenoxyacetate herbicides and superwarfarin rodenticides cause fewer deaths. This guide aims to present current best practice in the treatment of paraquat. Theoretically, absorption of an ingested dose of paraquat may be reduced by 1 gastric lavage, 2 induced emesis, 3 wholegut lavage or 4 by the oral.
At lower doses death may be delayed for several weeks. While evidence is limited, the treatment of diquat poisoning is generally the same as that for paraquat poisoning. Experience in hospital taiping year 2008 october 2011 med j malaysia vol 68 no 5 october 20 385 in malaysia, numerous cases of intentional self poisoning with paraquat have been reported. Medical management of paraquat ingestion request pdf. The first aim is to clear the gastrointestinal tract by inducing emesis and performing gastricgut lavage. Plasma paraquat concentrations, urine and plasma dithionite tests and clinical features provide a good guide to prognosis. Ingestion of even slight quantities of the herbicide paraquat often leads to a fatal outcome within 24 hours due to damage of cell membranes by superoxide ions o with subsequent necrosis of liver, heart, kidneys, and adrenals. Treatment following intoxication with lethal dose of paraquat.