Fatal Paraquat Poisoning: A Case Report
DOI:
https://doi.org/10.37506/2hn6bd35Keywords:
Paraquat, , herbicide , poisoning, , toxicology, , antidote,, multi-organ failureAbstract
Abstract:
Paraquat, a widely used herbicide, is notorious for its high toxicity and limited antidotal options. This case report details the clinical presentation, management strategies, and outcomes of a patient with paraquat poisoning. A 32-year-old male presented to the emergency department with a history of intentional ingestion of paraquat. The patient exhibited signs of acute toxicity, including gastrointestinal distress, respiratory distress, and multi-organ failure. Prompt recognition and initiation of treatment were crucial in navigating the complex clinical course. The treatment protocol involved aggressive decontamination, administration of activated charcoal, and utilization of specific antidotes such as cyclophosphamide and methylprednisolone. The patient received supportive care, including mechanical ventilation and hemodynamic support. Continuous monitoring of renal and hepatic functions was implemented to detect and manage complications promptly. Despite the aggressive therapeutic approach, the patient faced significant challenges, with progressive deterioration of respiratory and renal functions. The case highlights the limited efficacy of current treatment modalities in severe paraquat poisoning. The patient eventually succumbed to multi-organ failure, underscoring the need for further research to explore alternative interventions. Paraquat poisoning remains a significant clinical challenge with high mortality rates. This case report emphasizes the importance of early recognition, aggressive decontamination, and advanced supportive care in managing paraquat toxicity. Further research is imperative to explore novel treatment strategies and improve outcomes in cases of severe paraquat poisoning.
References
Blanco-Reina E, Saiz-Rodríguez M, Llerena A. Safety and efficacy of paraquat self-poisoning prevention through restricted sales. Clin Toxicol. 2019;57(1):9-15.
Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72(5):745-757.
Wesseling C, van Wendel de Joode B, Ruepert C, León C, Monge P, Hermosillo H, et al. Paraquat in developing countries. Int J Occup Environ Health. 2001;7(4):275-286.
Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, Remião F, Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2008;38(1):13-71.
Leong PK, Chen HY, Ko KM. Mitochondrial-targeted paraquat and metformin mediate ROS production to induce multiple pathways of retrograde signaling: A dose-dependent phenomenon. J Cell Mol Med. 2015;19(11):2553-2565.
Hou Y, Wang Y, Wang H, Xu J, Zheng Y. Identification of paraquat-induced ferroptosis in lung epithelial cells. Toxicol In Vitro. 2018;52:110-119.
Wilks MF. Mechanism of action of paraquat. Toxicology. 2003;187(1):1-2.
Klein-Schwartz W, Smith GS. Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States. Ann Emerg Med 1997;29(2):232–238.
Sittipunt C. Paraquat poisoning. Respiratory care. 2005 Mar 1;50(3):383-5.
Chaudhary R, Singh RR, Tripathi SK, Yadav PK. Trends of Poisoning Cases Coming to a Tertiary Care Center in Lucknow: A Retrospective Observational Study. Prof. SK Dhattarwal. 2024 Jan;18(1):109
Buckley, N. A., & Eddleston, M. (2011). Clinical management of paraquat poisoning. Toxicological Reviews, 30(2), 81-97.
Pakravan, N., Wesseling, S., Aguirre, E., & Pras, N. (2014). Paraquat Poisoning: A case report and review of the literature. Case Reports in Medicine, 2014, 1-8.
Senarathna L, Eddleston M, Wilks MF, Woollen BH, Tomenson JA, Roberts DM, et al. Prediction of outcome after paraquat poisoning by measurement of the plasma paraquat concentration. QJM. 2009;102(4):251-259.
Eddleston M, Wilks MF. Management of paraquat poisoning. Toxicol Rev. 2003;22(2):129-137.
Bismuth C, Garnier R. Porphyric crisis induced by paraquat poisoning: A clinical and toxicological study of 55 cases. Medicine. 1987;66(4):218-229.
Proudfoot AT, Stewart MS, Levitt T, Widdop B. Paraquat poisoning: significance of plasma-paraquat concentrations. Lancet. 1979;313(8111):330-332.
Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, Remião F, Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2008;38(1):13-71.
Heyndrickx A, De Broe ME. The effect of N-acetylcysteine on the clinical course of acute urethral poisoning with paraquat. J Toxicol: Clin Toxicol. 1980;17(1-2):185-188.
Feng MX, Lu YQ. Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?. World Journal of Emergency Medicine. 2021;12(3):232.
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