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Paraquat Poisoning

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Paraquat Poisoning Paraquat Poisoning Paraquat: highly toxic herbicide causing multi-organ failure Primary concern: progressive pulmonary fibrosis leading to respiratory failure Rapid intervention critical due to fast absorption and distribution Toxicokinetics Absorption: rapid but incomplete via ingestion Distribution: lungs (primary target), liver, kidneys, muscles Elimination: 90% unchanged in urine within 12-24 hours Lungs: active transport into type II pneumocytes; slow elimination Pathophysiology Primary mechanism: generation of reactive oxygen species (ROS) Cellular damage occurs through: Lipid peroxidation NF-κB activation Mitochondrial dysfunction Apoptosis induction Clinical Classifications Mild/subacute: less than 20 mg paraquat ion/kg Moderate to severe: 20-40 mg paraquat ion/kg Fulminant: above 40 mg paraquat ion/kg Early Clinical Manifestations (hours) Oral/esophageal ulcerations ("paraquat tongue") Gastrointestinal symptoms: nausea, vomiting, diarrhea, abdominal pain Late Clinical Manifestations (days-weeks) Multi-organ dysfunction: renal failure, liver dysfunction Cardiovascular: hypotension, tachycardia Pulmonary: respiratory distress, fibrosis Neurological: confusion, seizures, coma Diagnosis - Clinical Assessment History of exposure/ingestion Physical examination focusing on: Oral mucosa Respiratory status Hemodynamic stability Diagnosis - Laboratory Evaluation Urine dithionite test (rapid screening) Plasma paraquat concentration Comprehensive metabolic panel Arterial blood gases Complete blood count Amylase/lipase Management - Primary Goals 1. Stabilization and supportive care 2. Gastrointestinal decontamination 3. Enhanced elimination Management - Initial Management ABCs assessment Antiemetics administration Activated charcoal or Fuller's earth Management - Ongoing Care Avoid supplemental oxygen unless severe hypoxia Fluid management for renal clearance Early nutritional support Pain management and sedation as needed Specific Interventions Based on Severity Hemodialysis/hemoperfusion (within 4 hours post-ingestion) Immunosuppression: corticosteroids, cyclophosphamide Antioxidant therapy: Vitamin C, E, N-acetylcysteine Prognosis - Factors Affecting Outcome Quantity ingested Time to medical intervention Plasma paraquat concentration Prognosis - Long-term Complications Pulmonary fibrosis Esophageal strictures Chronic renal failure Prevention Public education on toxicity Access restriction Promotion of safer alternatives Take Home Message No known antidote Early recognition and intervention crucial Supportive care is cornerstone of management High mortality rate, especially with large ingestions Prevention remains the best strategy