PURPOSE: Plasma Paraquat level is one of the most important prognostic factors used in identifying Paraquat poisoning. Urine sodium dithionite tests are widely used in clinical settings for detecting the presence of Paraquat chemicals and predicting prognosis, but this test is subjective and qualitative. In this prospective study, we evaluated the correlation between sodium dithionite test results as measured by a colorimeter, versus actual plasma or urine Paraquat levels. METHODS: Plasma and urine sample were taken from patients upon arrival at a local emergency center (ED) within 12 hours after Paraquat ingestion. Urine was tested using sodium dithionite reaction and the resulting urine color was measured by colorimeter to result in an L (lightness) value. RESULTS: A total of 23 patients were enrolled in this study with a mean age of 57 years old, mean Paraquat intoxication volume of 94 mL, and mean Paraquat intoxication prior to ED arrival of 3.2 hours. The patients' mean blood Paraquat concentration was 82.23 microg/ml and urine Paraquat concentration was 169.19 microg/ml. Using the sodium dithionite test, 17 patients were diagnosed as beyond 'strong positive'. L values were correlated with intoxication volumes, blood Paraquat concentrations, and urine Paraquat concentrations. Blood Paraquat concentrations showed significant correlation with L value, poison volume, urine Paraquat volume, and creatinine values. CONCLUSION: The greater the intoxicated Paraquat volume, blood Paraquat concentration, and urine Paraquat concentration, the lower the L value.
Blood Volume ; Colorimetry ; Creatinine ; Dithionite ; Eating ; Emergencies ; Humans ; Paraquat ; Plasma ; Prognosis ; Prospective Studies ; Sodium

PURPOSE: Paraquat is a chemical which causes death in 30~80% of patients even after ingestion of small quantities. In spite of much studies, there are no successful treatment modalities or predictive parameters for determining the prognosis of the poisoning. The aims of this study were to evaluate plasma-paraquat concentration and initial laboratory and clinical data as prognostic parameters in patients with paraquat poisoning. METHODS: A retrospective analysis by chart review was done on 168 patients over three years who had ingested paraquat. The patients were divided into two subgroups based on survival and evaluated for ingested amounts of paraquat, the time between ingestion and treatment, urine dithionite test, and plasma paraquat concentration at the time of emergency department (ED) visit. Other clinical and laboratory factors such as age, sex, serum biochemical parameters, and severity index of paraquat poisoning (SIPP) were also analyzed. RESULTS: The plasma paraquat concentrations in the mortality group were higher than in the survival group (51.59+/-55.07 vs. 1.09+/-3.09 microgram/mL, p<0.001). The SIPP was higher in the mortality group as well (173.87+/-219.67 vs. 5.18+/-13.51 microgram/mL/hour). Among the laboratory data obtained in the ED, s-Potassium, s-Protein, arterial pH, PaCO2, bicarbonate, s-Albumin, s-Amylase, AST, BUN, s-Creatinine, and s-Glucose were significant factors which could affect the prognosis for paraquat poisoning. A Cox regression analysis revealed that plasma paraquat concentration, SIPP, s-Creatinine, s-Protein, s-Potassium and bicarbonate were associated with mortality. In addition, SIPP was more significantly correlated with mortality than plasma paraquat concentration (OR 1.362 vs. 1.011, p<0.001 vs. 0.019). CONCLUSION: Initial laboratory parameters including s-creatinine, s-protein, s-potassium, bicarbonate, plasma Paraquat concentration, and SIPP were significant prognostic factors. In addition, the author suggests that SIPP is a better index than plasma paraquat concentration for predicting the outcome of patients admitted for ingestion of paraquat.
Dithionite ; Eating ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Paraquat ; Plasma ; Prognosis ; Retrospective Studies ; Severity of Illness Index

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.
Agriculture ; Dithionite ; Eating ; Humans ; Logistic Models ; Mortality ; Odds Ratio ; Paraquat* ; Plasma ; Poisoning* ; Prognosis* ; Risk Factors

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.
Agriculture ; Dithionite ; Eating ; Humans ; Logistic Models ; Mortality ; Odds Ratio ; Paraquat* ; Plasma ; Poisoning* ; Prognosis* ; Risk Factors

To conduct a kinetic study of paraquat (PQ), we investigated 9 patients with acute PQ intoxication. All of them ingested more than 20 ml of undiluted PQ herbicide to commit suicide and arrived at our hospital early, not later than 7 h after PQ ingestion. The urine dithionite test for PQ in all of the nine patients was strongly positive at emergency room. Blood samples were obtained every 30 min for the first 2~3 h and then every 1 or 2 h, as long as the clinical progression was stable among the patients for 30 h after PQ ingestion. The area under the plasma concentration-time curve (AUCinf), which was extrapolated to infinity, was calculated using the trapezoidal rule. Toxicokinetic parameters, such as the terminal elimination half-life, apparent oral clearance, and apparent volume of distribution (Vd/F) were calculated. The maximum PQ concentration (Cmax) and the time to reach maximum PQ concentration (Tmax) were also obtained. Plasma PQ concentrations in nine patients were well described by a bi-exponential curve with a mean terminal elimination half-life of 13.1+/-6.8 h. Cmax and AUCinf were 20.8+/-25.7 mg/l and 172.5+/-160.3 h.mg/l, respectively. Apparent volume of distribution and apparent oral clearance were 50.9+/-61.3 l/kg and 173.4+/-111.2 l/h, respectively. There were a significant correlation (r =0.84; p<0.05) between the PQ amount ingested and Cmax. AUCinf also showed a significant correlation (r =0.83; p<0.05) with the PQ amount ingested. These correlations provide evidence that PQ has dose-linear toxicokinetic characteristics.
Dithionite ; Eating ; Emergency Service, Hospital ; Half-Life ; Humans ; Paraquat* ; Pharmacokinetics* ; Plasma ; Poisoning* ; Suicide

PURPOSE: Paraquat, a globally used herbicide, is highly toxic to human beings. Hence, we reviewed some cases of paraquat poisoning in Korea. METHODS: We analyzed the clinical and laboratory findings of 50 patients poisoned with paraquat retrospectively. The patients were admitted to the department of internal medicine in the Eumseong KeumWang hospital from January 2008 to December 2008. RESULTS: Among 50 cases of paraquat poisoning, 28 cases were male. Twenty-four cases (48%) were over 60 years old. Fourty-nine patients ingested paraquat on purpose as suicidal attempts, while 1 patient underwent accidental ingestion. Seven patients swallowed less than one mouthful of paraquat, of which 4 patients survived. Eleven patients swallowed two mouthfuls of paraquat, of which 8 patients survived. Thirty-two patients swallowed over three mouthfuls of paraquat and they all died. Thirty-one patients with leukocytosis died. Twenty-one patients with metabolic acidosis died. Increased levels of blood amylase and glucose were related to high mortality, and increased level of blood creatinine was related to severe mortality. Hemoperfusions were accomplished in 27 patients of paraquat poisoning, of which 12 patients survived. CONCLUSION: Paraquat is a highly toxic herbicide. When patients arrive at the hospital, laboratory findings, urine paraquat concentrations, arrival time, and the amount of paraquat consumed must be considered for treatment plan.
Acidosis ; Amylases ; Creatinine ; Dithionite ; Eating ; Glucose ; Hemoperfusion ; Humans ; Internal Medicine ; Korea ; Leukocytosis ; Male ; Mouth ; Paraquat ; Retrospective Studies

PURPOSE: Paraquat is widely used non-selective contact herbicide. In spite of efforts to improve the outcome in paraquat poisoning, the mortality rate still remains high. The purpose of this study is to assess the predictive factors of prognosis by investigating initial laboratory data on paraquat poisoning. METHODS: The author retrospectively analyzed the clinical features, laboratory data, and outcomes for 130 paraquatpoisoning patients treated from June 1997 to September 2003 at the emergency medical center of Chonnam National University Hospital. RESULTS: The results were as follows: 1) The mortalities were significantly older than the survivors (49.3 years vs 37.6 years, p<0.05). Among the total 130 cases, the survivors numbered 50, and the deceased numbered 80. The mean age of all 130 cases was 44.8+/-16.9 years. 2) The white blood cell count and the levels of serum AST and ALT in the deceased were significantly higher than they were in the survivors. The levels of arterial pH, PaCO 2, base excess, HCO3 -, and serum potassium in the survivors were significantly higher than they were in the deceased. 3) A multivariate Cox-Regression analysis revealed that sex, serum potassium, and arterial HCO3 - were associated with the mortality rate. CONCILUSION: The above data reveal that the ingested amount, the result of the urine sodium dithionite test, and the initial state of laboratory parameters, including the white blood cell count, ABGA (pH, PaCO2, HCO3 -, base excess), serum potassium, AST, and ALT, can be used to predict the outcome of paraquat poisoning.
Dithionite ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Jeollanam-do ; Leukocyte Count ; Mortality ; Paraquat* ; Poisoning* ; Potassium ; Prognosis* ; Retrospective Studies ; Survivors

BACKGROUND/AIMS: Paraquat is a potentially lethal herbicide that induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. This study examined the usefulness of hemoperfusion in paraquat poisoning. METHODS: We reviewed the medical records of 27 patients who underwent hemoperfusion after paraquat poisoning at Eumseong Keumwang Hospital from January 2009 to January 2010. RESULTS: All 27 paraquat-poisoning patients underwent hemoperfusion therapy within 6 hours of ingestion, and 13 patients survived. Patients who had ingested more than four mouthfuls died with 24 hours despite hemoperfusion. The mean arrival time at the emergency room and the plasma paraquat concentration in the survivors was 3.08 hours and 1.30 microg/mL, respectively; after hemoperfusion, the mean elapsed time was 8.92 hours and the plasma paraquat level was 0.14 microg/mL. The mean arrival time at the emergency room and plasma paraquat concentration in the non-survivors was 2.93 hours and 50.52 microg/mL, respectively; after hemoperfusion, the mean elapsed time was 9.36 hours, and the plasma paraquat level was 40.52 microg/mL. CONCLUSIONS: Urgent hemoperfusion therapy is essential for complete recovery from paraquat poisoning in patients who do not have metabolic acidosis or renal failure. However, hemoperfusion is not effective in those who ingested large amount of paraquat or have a urine dithionite of 4+, metabolic acidosis, or acute renal failure.
Acidosis ; Acute Kidney Injury ; Dithionite ; Eating ; Emergencies ; Hemoperfusion ; Humans ; Medical Records ; Mouth ; Paraquat ; Plasma ; Renal Insufficiency ; Respiratory Insufficiency ; Survivors

BACKGROUND: Paraquat has been widely used as a non-selective contact herbicide and it may induce damage to many organs. This study aimed to assess the factors that can predict the prognosis of paraquat poisoning and to determine the effect of hemoperfusion. METHODS: We retrospectively reviewed 132 patients who were poisoned with paraquat from January 2005, to December 2008. The patients were divided into two groups: The first groups included the death and survived groups, and the second groups included the hemoperfusion and non-hemoperfusion groups. We investigated the mortality, the factors that can predictive the prognosis and the effect of hemoperfusion. RESULTS: There were 79 males and 53 female (mean age: 56.1 +/- 15.1 years). The significant differences between the death and survival groups were the volume of paraquat ingested, the mental status, GCS (Glasgow coma scale), pH, base deficit, HCO3, serum Cr (creatinine), serum AST (aspartate transaminase), serum glucose, K (kalium), urine sodium dithionite test and hemoperfusion. The significant differences between the hemoperfusion and non-hemoperfusion groups were the mortality and the mean survival time. Multivariate regression analysis reveled four predictive factors and their's Odd ratio: 1) urine sodium dithionate test = strong 14.256, 2) hemoperfusion 0.493, 3) Cr > 0.95 mg/kg 31.603 and 4) an amount of ingested paraquat > 45 ml 16.945. CONCLUSIONS: The predictive factors for mortality were the amount of paraquat ingested > 45 ml, a urine sodium dithionite test = strong and a serum Cr > 0.95 mg/dl. Hemoperfusion couldn't be used a predictive factor for mortality, but it increased the mean survival time.
Coma ; Dithionite ; Female ; Glucose ; Hemoperfusion ; Humans ; Hydrogen-Ion Concentration ; Hypokalemia ; Male ; Paraquat ; Prognosis ; Retrospective Studies ; Sodium ; Sulfates ; Survival Rate

In South Korea, attempted suicide by paraquat (PQ) intoxication is fairly common, and is lethal by pulmonary fibrosis and hypoxemia. However, the treatment of PQ poisoning is primarily supportive management. To increase the survival rate associated with PQ intoxication, many treatments have been developed. Here, we treated a case of PQ intoxication with steroid pulse therapy. A 23-year-old man was admitted to the hospital because of PQ intoxication. He drank two mouthfuls of Gramoxon (24% commercial paraquat). His vital signs were stable, but he had a throat infection, and navy blue urine in the sodium dithionite test. Standard treatment, including gastric lavage with activated charcoal was performed, and emergent hemoperfusion with a charcoal filter was initiated 11 h after PQ ingestion. Pharmacotherapy was initiated 18 h after PQ ingestion with the administration of 5 mg dexamethasone. On day 10, chest PA showed pulmonary fibrosis. Therefore, we initiated steroid pulse therapy, with 1 g methylprednisolone in 100 mL of D5W administered over 1 h repeated daily for 3 days, and 1g cyclophosphamide in 100 mL of D5W administered over 1 h daily for 2 days. On day 15, dexamethasone therapy was initiated. On day 30, pulmonary fibrosis was improved. Thus, if pulmonary fibrosis becomes exacerbated after dexamethasone therapy during the subacute stage, pulse therapy with methylprednisolone and cyclophosphamide could be helpful.
Anoxia ; Charcoal ; Cyclophosphamide ; Dexamethasone ; Dithionite ; Eating ; Gastric Lavage ; Hemoperfusion ; Humans ; Methylprednisolone ; Mouth ; Paraquat ; Pharynx ; Pulmonary Fibrosis ; Republic of Korea ; Suicide, Attempted ; Survival Rate ; Thorax ; Vital Signs ; Young Adult