Use of Phlebotomy for management of paraquat toxicity: A pilot study

Bachground: Paraquat (PQ) intoxication manifests with pulmonary edema and fibrosis, heart failure, hepatic failure, and sometimes convulsions. In severe cases, the patients may die within the early hours. At best conditions, the conventional therapeutic methods can only save less than 50% of the victims of intentional PQ intoxication. The aim of this study was to evaluate the outcome of new therapeutic approaches particularly phlebotomy in PQ intoxication. Methods: Five patients enrolled in the present pilot study. The conventional therapeutic method consisting of gastric lavage, diuresis techniques, corticosteroids, immuno-suppressors, and antioxidants were applied in association with new interventions including early hemo-dialysis and the use of new antioxidants, especially phlebotomy. Results: One of the six patients who survived was excluded from the study. Four of five patients (80%) who were admitted with positive urine PQ test and treated with the modified method, could survived and only one case expired despite the interventional treatment and care. The mean age of patients was 25.21±3.47 years. Patients drank on average 52 ml of concentrated PQ. During admission, the mean Hb concentration was 16.79±2.11 g/dl that reduced to 8.95±0.93 g/dl on the second day of hospitalization. Conclusion: Phlebotomy causes fast circulation and remove toxin subjects. This study showed effect of phelebotomy and administration of antioxidants to treat PQ- intoxication. The new modified therapeutic method with phlebotomy surprisingly increased the survival rate up to 80%.