Paraquat poisoning: Experience of an Internal Medicine department

Abstract

Aims: To study the presentation, treatment and
evolution of Paraquat poisoning, looking for
prognostic indicators.
Material and Methods: A retrospective analysis of
Paraquat poisoning cases admitted to an Internal
Medicine department between January 1987 and
January 2000, using a data collection protocol, was
made. The following parameters were assessed:
demographic; quantity ingested and time from
ingestion to hospital arrival; evolution and mortality;
clinical manifestations and results of laboratorial tests
on and during admission; treatments instituted.
Results: 37 cases were documented: 19 died
(51.4%) after a mean time of 7 days, 18 survived
(48,6%) after a mean follow up of 7.5 months. The
appearance of jaundice, leucocytosis, renal failure
and hypoxaemia was significantly more frequent in
the patients who died. High values of lactic
dehydrogenase and low values of carbon dioxide
on admission were associated with worse prognosis.
Among the various treatment modalities used,
sodium sulphate, either isolated or associated with
gastric lavage and activated charcoal, had a
statistically significant favourable effect on survival
(used in 31% of the deceased and 55% of survivors).
Haemocarboperfusion was used more frequently in
the group of deceased patients (58% against 33%).
Other dialysis techniques were used infrequently.
Conclusions: The best prognostic indicator
(paraquatemia) was not available in our series.
Mortality correlates with the quantity of poison
ingested, resulting acutely from multi-organ failure,
or from late respiratory failure. Adsorbents and
cathartics are still the only confirmed prognostic
modifiers. Advantages of other therapeutic modalities, such as dialytic techniques, were not
found in this study.