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A6915 - Paraquat Poisoning, Case and Review of Literature
Author Block: T. M. Arab1, M. R. Malekzadegan2, L. Curiel3, O. Al Rramady4, M. Babury1; 1Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 2Pulmonary Medicine, Jamaica hospital medical center, Jamaica, NY, United States, 3Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, United States, 4Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Paraquat Poisoning: Case and Review of Literature
Introduction
Paraquat (PQ) is a widely used herbicide. In the US, PQ is restricted to professional users; however it is more widely available in developing countries. Since PQ is known to be highly toxic, ingestion as a mode of suicide is not uncommon. PQ ingestion can lead to gastrointestinal bleeding, and liver, kidney, lung, and heart failure. Its related death can occur up to 30 days after ingestion. We present a fatal case of PQ poisoning, with a review of literature.
Case
A 39-year-old male from South America presented after ingesting 100 ml of PQ 10 days prior to current admission. He had several admissions over the past week in South America for excessive vomiting, pain on swallowing, and renal impairment. He was initially treated with IV fluids and charcoal and later with pantoprazole, and antibiotics. His condition improved and he was discharged home. Three days later he developed a fever, dry cough, shortness of breath, and tachypnea, at which time he travelled to the US to receive medical care.
On current arrival, the patient had oxygen saturation of 85% on NRBM and was intubated. Chest X-ray showed interstitial changes in the middle and lower zones bilaterally. He had elevated BUN, creatinine, and leukocytosis. Empirical antibiotics, IV fluid, IV PPI and aggressive supportive measures were employed. Patient developed worsening infiltrates and had an increased oxygen requirement. He was treated with low tidal volume and high PEEP with the aim to decrease FIO2 and lung injury. Due to patient’s instability, transfer to an advanced center for hemoperfusion and ECMO was not possible. Hospital course was complicated by spontaneous pneumomediastinum and subcutaneous emphysema. Despite treatment, patient’s condition deteriorated and he passed away after 8 days
Discussion
Although restricted in the United States, PQ is easily accessible in developing countries. To date, there is no specific antidote for PQ poisoning. Early recognition and management are imperative to avoid fatal lung complications. Plasma and urine concentrations are useful diagnostic procedures; therapy includes charcoal within the first hour of exposure and providing continuous renal replacement therapy in addition to hemoperfusion. Prognosis has been linked to labs such as aspartate aminotransferase, the aspartate aminotransferase to alanine ratio, creatinine, prothrombin time, and prothrombin activity. Investigations with newer anti-fibrotic agents have recently been completed with the intention of reducing lung-injury due to PQ ingestion.