Original Article
Singapore Med J 2010; 51(6) : 496
Fatality in paraquat poisoning Sabzghabaee A M, Eizadi-Mood N, Montazeri K, Yaraghi A, Golabi M
ABSTRACT Introduction: Acute paraquat (PQ) poisoning continues to be a major public health concern in many developing countries. This study was designed to evaluate the data on cases of acute PQ poisoning and compare the different variables between survivors and non-survivors.
poisoning has been observed in patients who ingest the
pesticide either accidentally or intentionally as a suicide attempt.(3) PQ intoxication is more frequently fatal than
poisoning caused by other pesticides. The clinical
manifestation of PQ poisoning can be classified into three categories: (1) mild poisoning (less than 20 mg PQ
ion per kg of body weight), in which patients often have minor gastrointestinal symptoms and usually recover
Methods: All patients of PQ poisoning who were admitted to the poisoning emergency department during the past five years were retrospectively evaluated. The different variables that were compared between survivors and non-survivors included age and gender, the time from ingestion of PQ to hospital admission, the amount of PQ ingested, occurrence of vomiting after ingestion, the time from hospital admission to initiation of haemodialysis, the length of hospital stay and the outcomes.
fully; (2) severe poisoning (20–40 mg PQ ion per kg
of body weight), in which patients develop acute renal failure, acute lung injury and progressive pulmonary
fibrosis, with death occurring in 2–3 weeks as a result of Isfahan Clinical
Toxicology Research
respiratory failure; and (3) fulminant poisoning (more Centre,
than 40 mg PQ ion per kg of body weight), in which General Teaching patients develop multiple organ failure leading to death Hospital,
Noor and Ali-Asghar
within hours to a few days after ingestion.(4,5)
The mechanisms of PQ toxicity have been
evaluated by Dinis-Oliveira et al, and they have found Sabzghabaee AM, that the lung is the main organ for the accumulation DPhil, BCPS of PQ.(3) The generation of oxygen free radicals
Results: A total of 29 patients were evaluated. The in-hospital fatality rate was 55.2 percent. No significant differences were observed between survivors and non-survivors with regard to the patient characteristics. Most of the patients who died had ingested more than 40 mg/kg of 20 percent PQ (62.5 percent). There was a correlation between the outcome of patients and vomiting (p-value is 0.05; correlation coefficient is 0.45) and age (p-value is 0.013; correlation coefficient is 0.56). Conclusion: A large amount of ingested PQ, vomiting and age may be important variables to consider in association with the high fatality rate
Anaesthesiology
responsible for pulmonary injury.(3) The management and Intensive Care of PQ poisoning is quite difficult due to the lack of Eizadi-Mood N,
effective treatment that can be used in humans.(6) The MD, PhD failure of different treatments, such as treatment with Associate Professor absorbents, immunosuppressive therapy, radiotherapy, Yaraghi A, MD haemodialysis and haemoperfusion, has been reported Associate Professor in some studies.(5,7-10)
INTRODUCTION Pesticide poisoning is a major public health concern in
many developing countries and accounts for up to a third of all suicides worldwide.(1,2) Paraquat (PQ) is a widely
used pesticide that is applied to eliminate weeds. PQ
Department of
As acute PQ poisoning continues to be an important Emergency Poisoning
public health concern in many developing countries Golabi M, MD and is a common cause of mortality in presentations General Physician
of poisoning at emergency departments,(11) this study Anaesthesiology was designed to evaluate the data on cases of acute PQ and Intensive Care Department,
poisoning, and to compare the various determinants Al-Zahra Medical Centre, between survivors and non-survivors. METHODS
Singapore Med J 2010; 51(6): 496-500
Assistant Professor
after the reduction of PQ by intracellular oxidase is Department of
of PQ poisoning. Keywords: fatal, outcome, paraquat, poisoning
Ostandari Avenue, Isfahan 81458-31451, Iran
This study was conducted at the Research Department,
Soffeh Boulevard, Isfahan University of Medical Sciences, Isfahan 81746-75731, Iran
Isfahan University of Medical Sciences, Iran. The study Montazeri K, MD protocol was reviewed and approved by the Institutional Associate Professor Ethics
Committee. The poisoning emergency Correspondence to: department (PED) of our university hospital is the Dr Nastaran EizadiMood
main referral poisoning centre in the province, and is Tel: (98) 311 2222 127 designed exclusively for the management of poisoned Fax: (98) 311 2222 255 Email: izadi@med.
patients. Approximately 400 patients are admitted to the mui.ac.ir