Paraquat poisoning; an experience from a tertiary care center in India

Introduction: Paraquat poisoning is a commonly used toxin within the Indian sub-continent. Despite several advances in medical care, mortality in cases of paraquat poisoning continues to be high with controversies in the ideal management. Objectives: The aim of this study was to throw light on the clinical course of these patients in the current setting and evaluate some of the novel therapeutic options such as hemoperfusion in the setting of paraquat poisoning. Patients and Methods: This study is a retrospective observational study examining all adult patients with paraquat poisoning over the last five years from a tertiary care centre in Southern India. Demographic characteristics, clinical and laboratory profile, treatment options, and outcome were analysed from online hospital records. Results: Of 13 patients, all patients, except one, had ingested paraquat deliberately. Acute kidney injury (AKI) occurred in all patients (100%). Dialysis was required in 7 patients (54%) with AKI. Lung injury was seen in 63.5% of patients (n=8) and most patients i.e. 92.3% (12 patients) had multi-organ dysfunction syndrome (MODS). Hemoperfusion was provided to 30.8% of patients without much benefit in terms of duration of hospitalisation or time to death. Hemodialysis and continuous renal replacement therapy (CRRT) were offered for conventional indications. Dialysis was found to have significant bearing on time to death. Conclusion: Paraquat is a highly lethal herbicide with few effective therapeutic options. The majority of patients develop multi-organ dysfunction and succumb to death owing to circulatory collapse. Dialysis may be able to delay mortality in paraquat poisoning.