Paraquat is a commonly used herbicide in India that has lethal consequences even on minimal consumption. The case fatality rate for this poisoning is high and there is dearth of evidence-based recommendation for the treatment of this poison. This review article explores the diagnosis and management of paraquat poisoning with an emphasis on recent advances in treatment. Though immunosuppressants and antioxidants are conventionally used, there is a gap in evidence to prove survival benefit of these treatment regimens. There are also some data showing the use of hemoperfusion (with toxin-specific cartridges) as an early intervention, i.e., within 4 hours of exposure to the poison. The recent drug, Edaravone, has also shown promise in the prevention of renal and hepatic injury in paraquat poisoning. Though it did not reduce pulmonary fibrosis in patients with paraquat poisoning, it delays the generation and development of pulmonary fibrosis. However, there is a need for more clinical and experimental studies to validate its use in paraquat poisoning.
Wesseling C, Corriols M, Bravo V. Acute pesticide poisoning and pesticide registration in Central America. Toxicol Appl Pharmacol 2005;207(2 Suppl):697–705. DOI: 10.1016/j.taap.2005. 03.033.
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. DOI: 10.1080/10408440701669959.
Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health 2007;7:357. DOI: 10.1186/1471-2458-7-357.
Bullivant CM. Accidental poisoning by paraquat: report of two cases in man. Br Med J 1966;1(5498):1272–1273. DOI: 10.1136/bmj.1.5498.1272.
Wagner SL. Clinical toxicology of agricultural chemicals. Noyes Data Corporation; 1983. p. 306.
Lock EA, Paraquat WilksMF, In: Handbook of pesticide toxicology, 3rd ed., Krieger RI San Diego: Academic Press; 2010.
Honore P, Hantson P, Fauville JP, Peeters A, Manieu P. Paraquat poisoning “state of the art”. Acta Clin Belg 1994;49(5):220–228. DOI: 10.1080/17843286.1994.11718393.
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(5):373–377. DOI: 10.1097/MAJ.0b013e3181b4deee.
Xu S, Hu H, Jian Z, Tang S, Zhou Y, Sheng J, et al. APACHE score, severity index of paraquat poisoning, and serum lactic acid concentration in the prognosis of paraquat poisoning of Chinese patients. Pediatr Emerg Care 2015;31(2):117–121. DOI: 10.1097/PEC.0000000000000351.
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.
Roberts DM. Herbicides Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank's Toxicologic Emergencies, 10th ed., ch. 112 New York, NY: McGraw-Hill; 2015.
Hampson EC, Pond SM. Failure of hemoperfusion and hemodialysis to prevent death in paraquat poisoning - a retrospective review of 42 patients. Med Toxicol Adv Drug Exp 1988;3(1):64–71.
Li C, Hu D, Xue W, Li X, Wang Z, Ai Z, et al. Treatment outcome of combined continuous venovenous hemofiltration and hemoperfusion in acute paraquat poisoning: a prospective controlled trial. Crit Care Med 2018;46(1):100–107. DOI: 10.1097/CCM.0000000000002826.
Gawarammana IB, Buckley NA, Mohamed F, Naser KA, Jeganathan K, Munasinghe A, et al. A randomised controlled trial of high-dose immunosuppression in paraquat poisoning. Clin Toxicol 2012;50(4):278.
Li LR, Sydenham E, Chaudhary B, Naser KA, Jeganathan K, Munasinghe A, et al. Glucocorticoid with cyclophosphamide for paraquat-induced lung fibrosis. Cochrane Database Syst Rev 2014; 8. DOI: 10.1002/14651858.CD008084.pub4:CD008084.
Yi R, Zhizhou Y, Zhaorui S, Wei Z, Xin C, Shinan N. Retrospective study of clinical features and prognosis of edaravone in the treatment of paraquat poisoning. Medicine 2019;98(19):e15441. DOI: 10.1097/MD.0000000000015441.
Tang X, Sun B, He H, Li Hui, Hu Bin, Qiu Zewu, et al. Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning. Clin Toxicol 2015;53(9):908–913. DOI: 10.3109/15563650.2015.1082183.
