medical management and outcome of paraquat poisoning in ahvaz, iran: a hospital-based study

background: paraquat (pq) poisoning is highly fatal; and therefore, clinicians should be familiar with prompt approach to and poor prognostic features of this type of poisoning. hence, in this study, clinical profile, management and outcome of a series of patients with pq poisoning are presented. methods: a retrospective review of medical records of patients poisoned with pq who were treated at clinical toxicology department of razi hospital in ahwaz, iran during 2005 to 2008 was performed.  results: forty-two patients (66.7% men) were studied. majority of them (83.3%) were between 15-29 years of age. most of pq poisonings occurred following suicidal ideation (39 patients; 92.9%). the most common on-admission clinical findings of the patients were vomiting (69%) and respiratory distress (47.6%). activated charcoal was given to 35 patients (83.3%). n-acetyl cysteine (100 mg/kg iv stat), vitamin e (100 iu daily iv) and vitamin c (500 mg daily iv) were given to all patients. exploratory endoscopy for plausible mucosal ulcers was carried out for 23 patients (54.8%). pantoprazole (40 mg twice daily) was given to all patients and for 7 patients with upper gastrointestinal (gi) irritation and gi bleeding, higher doses of pantoprazole (8 mg/hour) was administered. all patients received pulse therapy with methyl prednisolone (1g daily for three days) and cyclophosphamide (15 mg/kg daily for two days). twenty patients died. comparing death and survival, death was significantly higher in patients with respiratory distress (100 vs. 0.0 %, p < 0.001), renal dysfunction (85.0 vs. 9.1 %, p < 0.001) and hepatic dysfunction (75.0 vs. 4.5 %, p < 0.001). conclusion: pq poisoning creates a life-threatening clinical situation, which requires quick and proper treatment. based on this research, mortality rate is greater in the presence of renal, hepatic and respiratory dysfunction.