Paraquat (1,1'-dimethyl-4, 4'-dipyridylium) is a broad-spectrum liquid herbicide associated with both accidental and intentional ingestion leading to severe and often fatal toxicity.1 Paraquat is actively taken up against a concentration gradient into lung tissue leading to pneumonitis and lung fibrosis. Paraquat also causes renal and liver injury.2 There are few case publications of paraquat poisoning and only few of them have reported that renal failure has ensued before acute respiratory distress syndrome (ARDS). Our patient presented with above lethal dose intake of paraquat containing substance and we did gastric lavage followed by charcoal hemoperfusion and hemodialysis but patient could not be saved despite optimum efforts suggesting the high fatality of this kind of poisoning.
Khosya S, Gothwal S. Two cases of paraquat poisoning from Kota, Rajasthan, India. Case Rep Crit Care. 2012;2012:652146. doi: 10.1155/2012/652146
Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72(5):745.757. doi: 10.1111/j.1365- 2125.2011.04026.x
Sandhu JS, Dhiman A, Mahajan R, Sandhu P. Outcome of paraquat poisoning-a five year study. Indian J Nephrol. 2003;13:64.68.
Singh S, Bambery P, Chaudhry D, Makharia G, Kakkar N, Singh D. Fatal paraquat poisoning: report of two cases. J Assoc Physicians India. 1999;47(8):831.832.
Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health. 2007;7(1):357. doi: 10.1186/1471-2458-7-357
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: Int J Med. 2009;102(4):251.259. doi: 10.1093/qjmed/hcp006
Dhadwad J, Shiddapur G, Borawake K, Patil H. Rapid onset pulmonary fibrosis due to paraquat poisoning. Medical Journal of Dr. DY Patil University. 2014 Jul 1;7(4):482.485. doi: 10.4103/0975-2870.135277
Weng CH, Hu CC, Lin JL, Lin-Tan DT, Huang WH, Hsu CW, et al. Sequential organ failure assessment score can predict mortality in patients with paraquat intoxication. PloS One. 2012;7(12):e51743. doi: 10.1371/journal.pone.0051743
Yang CJ, Lin JL, Lin-Tan DT, Weng CH, Hsu CW, Lee SY, et al. Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases. Liver Int. 2012;32(9):1400.1406. doi: 10.1111/j.1478- 3231.2012.02829.x
Sittipunt C. Paraquat poisoning. Respir Care 2005; 50:383.385. 09-