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

OBJECTIVETo study the protective effect of cerebrospinal fluid containing Qingxin Kaiqiao Fang on sodium dithionite (Na2S2O4)-induced PC12 cell injury, in order to provide basis for clinical application of the prescription.

METHODSD rats were orally administered with water decoction of Qingxin Kaiqiao Fang (7. 9 g . kg-1) once every 12 h, for a total of 7 times, in order to prepare cerebrospinal fluid containing Qingxin Kaiqiao Fang. The neurocyte injury model was established by adding Na2S2O4 with the final concentration of 8 m mol . L-1 into PC12 cells. With nimodipine (1 x 10(7)mol . L-1 ) as the positive control group, MTT method test was adopted to detect the impact of cerebrospinal fluid containing Qingxin Kaiqiao Fang on the activity of PC12 cells. The expression of Bax, Bel-2 and Caspase-3 mRNA was detected by RT-PCR.

RESULTThe cerebrospinal fluid containing Qingxin Kaiqiao Fang groups showed a significantly higher activity in PC12 cells than the model group, with decrease in expressions of Bax mRNA and Caspase-3 mRNA and increase in expression of Bel-2 mRNA. There were significant differences compared with the model group (P< 0. 05,P <0. 01).

CONCLUSIONQingxin Kaiqiao Fang shows a notable protective effect on Na2S2 04-induced neurocyte injury.

Animals ; Apoptosis ; drug effects ; Cerebrospinal Fluid ; chemistry ; Dithionite ; toxicity ; Drugs, Chinese Herbal ; pharmacology ; PC12 Cells ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Rats ; Rats, Sprague-Dawley

To identify a prognostic marker that is less sensitive to variations in the elapsed time since paraquat ingestion, we assessed the time between paraquat ingestion and a negative dithionite urine test as a prognostic parameter in patients with acute paraquat intoxication. Forty-one patients with acute paraquat intoxication were enrolled in this study and analyzed to verify significant determinants of mortality and organ dysfunction. The amount of paraquat ingested, paraquat plasma levels, and the time to a negative urine dithionite test were significant independent risk factors predicting mortality. The amount of paraquat ingestion, and the time to a negative urine dithionite test were independent risk factors predicting organ dysfunction. With a cut-off value of 34.5 hr for the time to negative conversion of the urine dithionite test, the sensitivity and specificity for mortality were 71.4% and 75.0%, respectively. The incidence of acute kidney injury and respiratory failure above 34.5 hr were 100% and 85.0%, respectively. In conclusion, the time to a negative urine dithionite test is the reliable marker for predicting mortality and/or essential organ failure in patients with acute paraquat intoxication, who survive 72 hr.
Acute Kidney Injury/etiology/mortality ; Adult ; Aged ; Dithionite/*urine ; Female ; Herbicides/blood/*toxicity ; Humans ; Liver Diseases/etiology/mortality ; Male ; Middle Aged ; Paraquat/blood/*toxicity ; Respiratory Insufficiency/etiology/mortality ; Risk Factors ; Time Factors

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

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 lethal herbicide and induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. The aims of this study are to investigate the correlation between plasma paraquat concentrations and initial laboratory data at Emergency Medical Center and to investigate whether initial laboratory data is useful for predicting outcomes of paraquat-poisoned patients. METHODS: A retrospective analysis by chart review was done on 83 patients who ingested paraquat and who had presented to Emergency center of within 24 hours. Plasma paraquat concentrations, urine dithionite test and initial laboratory parameters including white blood cell count, urine pH, and AST, ALT, BUN, Creatinine, Amylase, Glucose, pH, PaCO2, PaO2, HCO3. Base Excess, Na, K, Cl were obtained at the time of Emergency Center visit. We compared urine dithionite test, plasma paraquat concentrations and Severity Index of Paraquat Pisoning (SSPI) of the survival group to those of the dead group. The patients were divided into four subgroups based on the level of plasma paraquat concentration, their initial laboratory data was compared and analyzed. RESULTS: The mean plasma paraquat concentration in the mortality group was higher than that in the survival group (88.44+/-81.56 vs. 1.32+/-1.72 microgram/mL). Among the initial laboratory data of four subgroups, WBC, Glucose, Cr, pH, HCO3, Bass excess were significantly different between the group of low level of plasma paraquat concentration and higher group. ANCOVA analysis revealed that WBC, HCO3, Bass excess correlated with the level of plasma paraquat concentration significantly. CONCLUSION: The plasma paraquat concentration and SIPP were higher in the mortality group significantly. Initial laboratory data including WBC, Glucose, Cr, pH, HCO3, Bass excess were proven to be significant prognostic factors. Especially WBC, HCO3, Bass excess can be used to predict the outcome of paraquat poisoning.
Acute Kidney Injury ; Amylases ; Bass ; Creatinine ; Dithionite ; Emergencies ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Leukocyte Count ; Paraquat ; Plasma ; Prognosis ; Respiratory Insufficiency ; Retrospective Studies

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

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: To assess the ability of the Sequential Organ Failure Assessment (SOFA) score to predict the prognosis and organ dysfunction in the paraquat poisoning. METHODS: We retrospectively evaluated 281 paraquat poisoning patients who arrived at Soonchunhyang University Cheonan Hospital between Sep 2007 and Dec 2008. Sixty eight patients (68) were excluded due to missing data. Finally, 213 patents were included in this study. We investigated the degree of paraquat exposure, the Glasgow coma scale, vital signs, blood laboratory tests, calculated SOFA score, and Yamaguchi Index on first hospital day. The prognostic prediction was compared between SOFA score and Yamaguchi Index. RESULTS: The urine dithionite test, the amount of paraquat ingestion, arrival interval, aerum paraquat, Glasgow coma scale, HCO3-, potassium, and creatinine were significantly different between survivors and non-survivors. The Hosmer and Lemeshow Goodness-of-Fitness test of SOFA score (p=0.419) and Yamaguchi Index (p=0.084) indicated a good model performance. In the logistic regression analysis, p values the SOFA score and for the Yamaguchi Index were lower than 0.05 and the odds ratios were 1.930 and 0.108. At c-statistics, the area under receiver operator characteristic curve of SOFA score was 0.807 and Yamaguchi Index was 0.865. 95% confidence SOFA score and Yamaguchi Index Intervals of did not include 0.5. CONCLUSION: The SOFA score on the first day of hospital visit could reliably describe organ dysfunction and could distinguish survivors and non-survivors with reliable accuracy, as well as the Yamaguchi Index did in the case of paraquat poisoning.
Creatinine ; Dithionite ; Eating ; Glasgow Coma Scale ; Humans ; Logistic Models ; Multiple Organ Failure ; Odds Ratio ; Paraquat ; Potassium ; Prognosis ; Retrospective Studies ; Survivors ; Vital Signs

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