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.