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Paraquet poisoning

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https://emergency.cdc.gov/agent/paraquat/basics/facts.asp

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Paraquat poisoning is a medical emergency. Paraquat is a highly toxic herbicide that can cause corrosive mouth and throat injury, acute kidney and liver injury, shock, severe lung damage, and delayed irreversible pulmonary fibrosis. There is no specific antidote.

If exposure has just occurred

  • Swallowed: Call emergency services and go to an emergency department immediately. Do not induce vomiting and do not give anything by mouth unless instructed by a poison center or clinician.
  • On skin: Remove contaminated clothing and wash exposed skin thoroughly with soap and plenty of water.
  • In eyes: Irrigate continuously with clean water for 15-20 minutes.
  • Take the product container or a photo of its label to hospital if safe to do so.
The US Poison Control guidance states that swallowed paraquat requires emergency transport; its hotline is 1-800-222-1222. The Poison Control guidance also describes immediate skin and eye decontamination. For other countries, call the local emergency number or poison information center.

Hospital management

Management is urgent and specialist-led:
  • ABC resuscitation, IV fluids, renal and liver monitoring, arterial blood gases, ECG, and serial clinical assessment.
  • Early gastrointestinal adsorption with activated charcoal may be considered by clinicians, particularly very soon after ingestion.
  • Measure plasma or urine paraquat where available. A urine sodium dithionite test can provide rapid qualitative confirmation.
  • Hemoperfusion or intermittent hemodialysis may be considered very early after ingestion, but benefits are uncertain because paraquat rapidly enters tissues.
  • Oxygen is given only when clinically required for hypoxemia, because high oxygen exposure can aggravate paraquat-related oxidative lung injury. This is a clinician decision.
  • Corticosteroids, cyclophosphamide, antioxidants, and other approaches have been tried, but no regimen has clearly and consistently improved outcomes.
Severity depends heavily on dose and time to treatment. Ingestions around 20-40 mg/kg may lead to multiorgan failure, while higher exposures can cause death within days. The main late cause of death is respiratory failure from ARDS-like injury and pulmonary fibrosis. Brenner and Rector's The Kidney, 2-Volume Set, treatment section, pp. 2868-2869.
A recent systematic review addressed serum amylase as a prognostic marker, not a proven treatment change (PMID 41766261).
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