Paraquat (PQ) poisoning has become one of the common pesticide poisoning in China. PQ is extremely toxic to human beings. The fatality rate of oral PQ poisoning is more than 90%. So far, there is no specific antidote. Seek effective treatment measures for PQ poisoning has become the focus of clinical medical research. In November 2017, a patient with acute severe PQ poisoning was treated in the intensive care unit (ICU) of Shouguang People's Hospital Affiliated to Weifang Medical College. The patient refused blood purification therapy and was rescued successfully only by continuous fluid therapy, diuresis, catharsis and routine treatment. By reviewing the treatment process of this case, new treatment ideas for the clinical treatment of PQ poisoning in primary hospitals were provided. Patients with acute PQ poisoning should be rescued by immediate administration of emetic, gastric lavage, catharsis and oral montmorillonite powder. For those without dysfunction of heart, lung and and kidney, a large amount of fluid treatment and diuresis should be given immediately to promote the excretion of poison. The key to improve the success rate of rescue of acute PQ poisoning is to eliminate PQ from the body as soon as possible.

Objective: To explore the effect of occupational exposure to glyphosate on hepatorenal function. Methods: 526 workers who were occupationally exposed to glyphosate from 5 glyphosate-producing factories were selected as cases; and another 442 administrative staffs who were not exposed to glyphosate were selected as controls from April to November, 2014. All the subjects accepted occupational health examination. The concentration level of glyphosate in the air of workshop was detected and the time weighted average concentration (TWA) was calculated. And analyze the difference of hepatorenal fuction between case group and control group. Result: The age of the subjects in the case and control groups were separately (35.6±10.3), (34.3±9.7) years old, with the length of working for (6.5±5.7), (7.7±6.8) years. The TWA of glyphosate in the case group was between <0.03-48.91 mg/m³, with the geometric mean at 3.78 mg/m³. The overall rates of abnormal hepatic and renal function in the case group were 14.4% (76 cases) and 16.2% (85 cases), respectively; while those were 5.0% (22 cases) and 4.8% (21 cases), respectively in control group, and the difference showed statistical significance (P<0.05). When TWA reached <0.03-6.00 mg/m³, the difference of hepatorenal fuction between case group and control group showed statistical significance, and the rates of abnormal hepatic and renal function was 8.0% (36/447) and 9.8% (44/447) respectively in case group. When cumulative exposure level reached <1.56-68.64 g, the difference of hepatorenal fuction between case group and control group showed statistical significance, and the rates increased to 9.2% (37/404) and 10.4% (42/404) respectively in group of cases. Conclusion Glyphosate can affect the hepatic and renal function among occupational exposure population, and there was an association between the effect and the exposure dose.

Objective:To explore the clinical value of "hydration therapy" in the treatment of severe acute paraquat poisoning (APP).Methods:A prospective historical control observation was conducted. Fifty-eight patients with severe APP admitted to Shouguang People's Hospital Affiliated to Weifang Medical College from February 2014 to June 2019 were enrolled. Twenty-six patients admitted before May 10th, 2016 were enrolled in the standard treatment group. After being admitted to intensive care unit (ICU) from the department of emergency, patients in the standard treatment group were immediately given standard treatment such as repeated gastric lavage, catharsis, adsorption of poison by activated carbon or montmorillonite powder, drug treatment and blood purification. From May 10th, 2016, 32 patients were enrolled in the intensive treatment group. On the basis of standard treatment, "hydration therapy" was carried out, that was, 0.9% NaCl and/or 5% glucose injection were used for continuous intravenous infusion throughout the day, so as to ensure that the total amount of fluid infusion per day reached 200 mL/kg within 48-72 hours after ICU admission. At the same time, furosemide was used to strengthen diuresis to ensure the balance of water and electrolyte. If heart failure or acute pulmonary interstitial edema occurred during the treatment, "hydration therapy" should be stopped immediately. Six months after treatment, all patients were followed up. The patients with normal activity, no complaints of discomfort and no damage of heart, lung, liver, kidney and other organs were regarded as cured. The therapeutic effect of "hydration therapy" was evaluated.Results:There was no significant difference in gender, age, dosage or time from taking poison to ICU between the two groups. In the intensive treatment group, 32 patients did not appear heart failure during continuous rehydration treatment. Follow-up after 6 months showed that the overall cure rate in the intensive treatment group was significantly higher than that in the standard treatment group [59.4% (19/32) vs. 19.2% (5/26), P < 0.05]. In the 6-month follow-up, there was no significant difference in age or time from taking poison to ICU between the two groups, but the dosage in the intensive treatment group was significantly higher than that in the standard treatment group (mL: 54.06±26.03 vs. 23.00±4.47, P < 0.05). After 6 months of follow-up, chest CT showed that the lesions of pulmonary fibrosis of cured patients in both group gradually reduced with time, not completely progressive and irreversible. Conclusion:"Hydration therapy" with intensive diuresis can significantly improve the rescue success rate of patients with severe APP.