Table of Contents  
COMMENTARY
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 375  

Comment on paraquat poisoning treatment strategies


Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, 250012 Shandong, China

Date of Web Publication15-May-2015

Correspondence Address:
Xiangdong Jian
Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, 250012 Shandong
China
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Jian X. Comment on paraquat poisoning treatment strategies. Med J DY Patil Univ 2015;8:375

How to cite this URL:
Jian X. Comment on paraquat poisoning treatment strategies. Med J DY Patil Univ [serial online] 2015 [cited 2019 Dec 6];8:375. Available from: http://www.mjdrdypu.org/text.asp?2015/8/3/375/157091

Paraquat (N, N'-dimethyl-4, 4'-bipyridinium dichloride, PQ) is an effective herbicide that has favorable environmental characteristic with low price, which was synthesized in 1882 and has been first used as an herbicide since 1955. [1] But PQ is a highly toxic compound for, and the fatality rate of PQ ranged from 60% to 70% due to the lack of specific antidote. [2] While PQ is banned or rarely used in the developed world, PQ poisoning remains as a major cause of death among patients with acute poisoning in developing countries. [3] PQ poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. To serious paraquat patients, the effectiveness of conventional treatments is unsuccessful. Acute paraquat poisoning continues to be a major public health problem in China countryside sine 2000 years. The main risk of paraquat poisoning is still from deliberate ingestion or accidental exposure. [4] In China, paraquat is available and inexpensive, making poisoning prevention difficult. Intentional self-poisoning is the major reason for paraquat exposure and usually causes serious consequences. [5] It is still a controversial herbicide for it is highly toxic for humans. [6] Conventional therapy for paraquat poisoning both prevents further absorption and reduces the load of paraquat in the blood through hemoperfusion or hemodialysis. To serious paraquat patients, the effectiveness of standard treatments is unsuccessful. [7] A PQ dose of 30 mg/kg may be fatal. This is equivalent to 8-10 mL of the 20% solution sold commercially. [8] On the basis of treatment, a large number of paraquat poisoning cases, we have explored a set of paraquat poisoning treatment plan called "Qilu scheme." [9] Some severe paraquat poisoning patients survived after treatment according to these methods. [10] The main therapeutic principles are as follows:

  1. Field first aid and diseases assessment; taking Smecta, activated carbon and mannitol orally;
  2. The early gastrointestinal nutrition and treatment of digestive tract damage;
  3. Actively carry out early blood perfusion;
  4. Using glucocorticoids;
  5. Antioxidant treatment;
  6. Delayed use of cyclophosphamide, general 2 weeks late;
  7. When PaO 2 <40 mmHg or SaO 2 <70%, oxygen therapy is needed;
  8. Treatment of liver damage and renal damage;
  9. Treatment of hypokalemia;
  10. About extracorporeal membrane oxygenation and lung transplantation treatment on paraquat poisoning, a lot of problems unresolved;
  11. Traditional Chinese medicine therapy, such as Danshen injection, Xuebijing injection, et al.;
  12. Emphasis on long-term follow-up evaluation.


 
  References Top

1.
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;32:1400-6.  Back to cited text no. 1
    
2.
Seok SJ, Gil HW, Jeong DS, Yang JO, Lee EY, Hong SY. Paraquat intoxication in subjects who attempt suicide: why they chose paraquat. Korean J Intern Med 2009;24:247-51.  Back to cited text no. 2
    
3.
Wilks MF, Fernando R, Ariyananda PL, Eddleston M, Berry DJ, Tomenson JA, et al. Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka. PLoS Med 2008;5:e49.  Back to cited text no. 3
    
4.
Ruan YJ, Jian XD, Guo GR. Progress in research on mechanism of pathogenesis and treatment of acute paraquat poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2009;27:114-6.  Back to cited text no. 4
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5.
Shi Y, Bai Y, Zou Y, Cai B, Liu F, Fu P, et al. The value of plasma paraquat concentration in predicting therapeutic effects of haemoperfusion in patients with acute paraquat poisoning. PLoS One 2012;7:e40911.  Back to cited text no. 5
    
6.
Kan BT, Liu HM, Jian XD, Zhang W, Zhou Q, Wang JR. Clinical studies of dynamic changes on the renal injury indicators of acute paraquat poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2012;30:839-41.  Back to cited text no. 6
    
7.
Liu P, He YZ, Zhang XG, Li G, Wang HC, Lu XX, et al. Studying the therapeutic effects of hemoperfusion with continuous venovenous hemofiltration on the patients with acute paraquat poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2011;29:266-9.  Back to cited text no. 7
    
8.
Yoon SC. Clinical outcome of paraquat poisoning. Korean J Intern Med 2009;24:93-4.  Back to cited text no. 8
[PUBMED]    
9.
Jian X, Zhang H, Sui H, Guo G, Ruan Y, Wang Y, et al. Paraquat poisoning treatment "Qilu scheme". Chin J Ind Med (Chinese) 2014;27:119-21.  Back to cited text no. 9
    
10.
Yu G, Kan B, Jian X, Wang J, Sun J, Song C. A case report of acute severe paraquat poisoning and long-term follow-up. Exp Ther Med 2014;8:233-36.  Back to cited text no. 10
    




 

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