Document Type : Case Report

Authors

• Hamidreza Reihani
• Bahram Zarmehri

Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Paraquat is a herbicide that is used widely. Several voluntary and accidental paraquat poisoning have been reported in recent years. Gastrointestinal absorption of paraquat is rapid. Systemic effects include pulmonary injury, heart failure, acute renal failure and hepatic failure. Metabolic acidosis results from multi-organ failure. Due to these systemic effects, paraquat poisoning is associated with high rate of morbidity and mortality.
Case presentation: A 34-year old man has been referred from a nearby town to our educational hospital with abdominal pain, nausea, vomiting, jaundice, and decreased level of consciousness since 12 hours ago. In his history, he declared that he had drunk a glass of green colored herbicide 2 days ago as a suicidal attempt. Four hours after ingestion, he was brought to a regional hospital by family and after 24 hours of observation, he was discharged. He was symptom free during the observation. His clinical features and laboratory results on arrival to our hospital revealed multi-organ failure. Despite aggressive supportive treatment , he died at the second day of admission.
Conclusion: this case report emphasizes on the importance of early admission and treatment of paraquat poisonings, regardless of symptoms, to save the patient's life. Many supportive treatments must be carried out for these patients.
 
Gawarammana IB, Buckley NA. Medical management of 
paraquat ingestion. Br J Clin Pharmacol 2011;72:745-57.
2. Dinis-Oliveira RJ, Duarte JA, Sanchez-Navarro A, Remiao F, 
Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of 
lung toxicity, clinical features, and treatment. Crit Rev Toxicol
2008;38:13-71.
3. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, 
Cline DM. Tintinalli’s Emergency Medicine. New York: 
McGraw-Hill; 2016.
4. Jones AL, Elton R, Flanagan R. Multiple logistic regression 
analysis of plasma paraquat concentrations as a predictor of 
outcome in 375 cases of paraquat poisoning. QJM 
1999;92:573-8.
5. Koo JR, Yoon JW, Han SJ, Choi MJ, Park II, Lee YK, et al. 
Rapid analysis of plasma paraquat using sodium dithionite as a 
predictor of outcome in acute paraquat poisoning. Am J Med 
Sci 2009;338:373-7.
6. Liu XW, Ma T, Qu B, Ji Y, Liu Z. Prognostic value of initial 
arterial lactate level and lactate metabolic clearance rate in 
patients with acute paraquat poisoning. Am J Emerg Med
2013;31:1230-5.
7. Botella de Maglia J, Belenguer Tarin JE. Paraquat poisoning. 
A study of 29 cases and evaluation of the effectiveness of the 
"Caribbean scheme". Med Clin (Barc) 2000;115:530-3.
8. Lin JL, Lin-Tan DT, Chen KH, Huang WH, Hsu CW, Hsu HH, 
et al. Improved survival in severe paraquat poisoning with 
repeated pulse therapy of cyclophosphamide and steroids.
Intensive Care Med 2011;37:1006-13.
9. Li LR, Sydenham E, Chaudhary B, You C. Glucocorticoid with 
cyclophosphamide for paraquat-induced lung fibrosis. 
Cochrane Database Syst Rev 2010:CD008084.

Keywords

• Early Admission
• Multi-Organ Failure
• Paraquat Poisoning