Experience with paraquat poisoning in a respiratory intensive care unit in North India

Agarwal R, Srinivas R, Aggarwal AN, Gupta D
Correspondence: Dr Ritesh Agarwal, riteshpgi@gmail.com; ritesh@indiachest.org

ABSTRACT
Introduction Paraquat poisoning is an uncommon entity in India. We report our experience of managing five patients with paraquat poisoning using immunosuppressive therapy.
Methods Retrospective analysis of 84 patients admitted with a diagnosis of poisoning over the last eight years was performed. The data were presented in a descriptive fashion.
Results Five (5.9 percent) out of the 84 patients were admitted with a diagnosis of paraquat poisoning. All patients were mechanically ventilated. All patients had hepatic failure with median peak bilirubin being 22.1 +/- 15.1 mg/dL (range 8.4-45.5). Four of the five patients had renal failure (median peak creatinine 3.8 +/- 1.5 mg/dL; range 3.4-11.1) requiring renal replacement therapy. All patients were treated with intravenous methylprednisolone 15 mg/kg/day for three consecutive days and intravenous cyclophosphamide 10 mg/kg/ day for two consecutive days, followed by intravenous dexamethasone 4 mg thrice a day until recovery or death. Two out of the five patients survived. Three died because of severe acute respiratory distress syndrome and multiorgan dysfunction syndrome.
Conclusion Paraquat poisoning is an uncommon entity in India, and is associated with a high mortality rate. There is a potential role for immunosuppressive therapy in patients with moderate to severe poisoning.

Keywords: cyclophosphamide, immunosuppression, methylprednisolone, paraquat, poisoning
Singapore Med J 2006; 47(12): 1033-1037