Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication.
10.3346/jkms.2014.29.11.1441
- Author:
Hyo Wook GIL
1
;
Jung Rak HONG
;
Si Hyong JANG
;
Sae Yong HONG
Author Information
1. Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. syhong@sch.ac.kr
- Publication Type:Review ; Research Support, Non-U.S. Gov't
- Keywords:
Paraquat;
Reactive Oxygen Species;
Antioxidants;
Hemoperfusion
- MeSH:
Acute Kidney Injury/*diagnosis/pathology/therapy;
Antioxidants/therapeutic use;
Creatinine/blood;
Hemoperfusion;
Herbicides/*poisoning;
Humans;
Iron Chelating Agents/therapeutic use;
Lung Diseases/*diagnosis/pathology/therapy;
Paraquat/blood/*poisoning/urine;
Tomography, X-Ray Computed
- From:Journal of Korean Medical Science
2014;29(11):1441-1449
- CountryRepublic of Korea
- Language:English
-
Abstract:
Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.
