Introduction:
Paraquat poisoning has become a serious public health concern, especially in rural parts of India, due to its easy access and lack of awareness of potential harms. It causes a spectrum of complications including acute respiratory distress syndrome, renal failure, hepatotoxicity, and pulmonary fibrosis. Due to absence of antidote, there is a high mortality rate of 70-80%.
Methods:
CASE SERIES:
Case 1: 24 year old male presented to the emergency with consumption of 15-20 ml of 20 percent (weight/volume) paraquat consumption 24 hours prior to presentation. He was asymptomatic and hemodynamically stable with Serum creatinine of 2.5 mg/dl on presentation. He was started on hemodiafiltration on consecutive days. However his creatinine increased progressively and he succumbed due to multiorgan dysfunction on day 2 of admission.
Case 2: 31 year old male had history of consumption of around 5-10 ml of 20% paraquat and presented to emergency within 4 hours of consumption. He was immediately started on hemodiafiltration. His hemodynamic and laboratory parameters remained normal throughout the hospital stay. He was discharged on day 15 in stable condition.
Case 3: 28 year old male came to the emergency within 2 hours of 10 % paraquat consumption. He was started on hemodiafiltration for 2 consecutive days. His creatinine started to increase on day 4 of admission to a peak of 4.5 mg/dl. One session of hemodialysis cwas given on day 5 in view of fluid overload. His creatinine subsequently decreased and he has discharge on day 12 with creatinine of 0.8 mg/dl.
All the patients were treated with gastric decontamination, intravenous fluids and injection methylprednisolone followed by oral steroids. Both the patients who were discharge were followed up for a period of 60 days and were doing fine without any complications.
Results:
Two of the three patients who consumed paraquat survived and normal renal function at 60 days post discharge. One patient died due to respiratory failure.
Conclusions:
Paraquat is a toxic bipiridyl compound which can lead to rapid multiorgan dysfunction with early onset acute kidney injury. Hemoperfusion has been the most used extracorporeal therapy. However it is not easily available and has a higher incidence of complications when compared to other modes of extracorporeal therapy. Hemodiafiltration (HDF) due to use of convective fluid can reduce the inflammatory mediators and toxic by-products and offer an alternative less expensive modality to hemoperfusion. By decreasing the cytokines and inflammatory products HDF can reduce subsequent organ damage. Late presentation and amount of paraquat consumed are bad prognosis markers and usually do not respond to extracorporeal therapy.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.