Paraquat-induced acute kidney and liver injury: Case report of a survivor from Bangladesh

Utility of Clinical Variables for Deciding Palliative Care in Paraquat Poisoning: A Retrospective Study

Background

Patients with paraquat poisoning (PP) have a mortality rate comparable to that of advanced malignancies, yet palliative care is seldom considered in these patients. This audit aimed to identify triggers for early palliative care referral in critically ill patients with PP.

Methods

Medical records of patients with PP were audited. Predictors of mortality within 48 hours of hospitalization and 24 hours of intensive care unit (ICU) admission were considered as triggers for palliative care referral.

Results

Among 108 patients, 84 complete records were analyzed, and 53 out of 84 (63.1%) expired. Within 48 hours after hospitalization, the lowest oxygen partial pressure in arterial blood to a fraction of inspired oxygen [the ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) (PaO2/FiO2)] was the independent predictor of mortality, cut-off ≤ 197; the area under the curve (AUC), 0.924; sensitivity, 97%; specificity, 78%; p <0.001; and 95% confidence interval (CI): 0.878-0.978. Kaplan-Meier survival plot showed that the mean survival time of patients with the lowest PaO2/FiO2, ≤197, was 4.64 days vs 17.20 days with PaO2/FiO2 >197 (log-rank p < 0.001). Sequential organ failure assessment (SOFA) score within 24 hours of ICU admission had a cut-off ≥9; AUC, 0.980; p < 0.001; 95% CI: 0.955-1.000; 91% sensitivity; and 90% specificity for mortality prediction. Out of the total of 84 patients with PP analyzed, there were 11 patients admitted to the high dependency units (13.1%) and 73 patients admitted to the ICU (86.9%). Out of the total of 84 patients of PP in whom data was analyzed, 53 (63.1%) patients required ventilator support. All the 53 patients who required ventilator support due to worsening hypoxemia, eventually expired.

Conclusion

The lowest PaO2/FiO2 ≤ 197 within 48 hours of hospitalization, SOFA score ≥9 within 24 hours of ICU admission or need for mechanical ventilation are predictors of mortality in PP patients, who might benefit from early palliative care.

How to cite this article

Rao S, Maddani SS, Chaudhuri S, Bhatt MT, Karanth S, Damani A, et al. Utility of Clinical Variables for Deciding Palliative Care in Paraquat Poisoning: A Retrospective Study. Indian J Crit Care Med 2024;28(5):453-460.

Diagnostic Dilemma in Fatal Paraquat Poisoning: An Autopsy Case Report

Paraquat is a highly toxic agent used as an herbicide worldwide. Despite its easy and widespread availability, data regarding cases of paraquat poisoning in India is limited. Diagnosis often becomes difficult without a clear history, owing to its rather nonspecific and varying presentation. In the present case, a 22-year-old man was brought with a history of high-grade fever, sore throat, and oral ulcers for around a week. He was symptomatically treated at multiple hospitals and was worked up for suspected diagnoses like diphtheria and influenza (H1N1). Later during treatment, it was revealed that "Paraxzone" was procured online by the patient himself two weeks before the onset of his symptoms. Thence, the treatment regimen was modified following suspicion of paraquat poisoning. However, the delay in diagnosis led to the worsening his condition, and the patient succumbed to death due to pulmonary and renal complications after 16 days of survival. The postmortem examination, supplemented with histopathological evaluation, supported the diagnosis of paraquat poisoning. Paraquat poisoning can mimic a myriad of clinical conditions. Thorough history taking, a high degree of suspicion, and collaborative work with the investigating agency are of paramount importance while dealing with cases of suspected paraquat poisoning in hospital settings.

Electrochemical paraquat sensor based on lead oxide nanoparticles

1,1-Dimethyl-4,4-bipyridinium dichloride known as paraquat is a popular well-known herbicide that is widely used in agriculture around the world. However, paraquat is a highly toxic chemical causing damage to vital organs including the respiratory system, liver, heart, and kidneys and death. Therefore, detection of paraquat is still necessary to protect life and the environment. In this work, an electrochemical sensor based on lead oxide nanoparticles (PbO-NPs) modified on a screen-printed silver working electrode (SPE) has been fabricated for paraquat detection at room temperature. The PbO-NPs have been synthesized by using a sparking method via two Pb metal wires. The electrochemical paraquat sensors have been prepared by a simple drop-casting of PbO-NPs solution on the surface of the SPE. The PbO-NPs/SPE sensor exhibits a linear response in the range from 1 mM to 5 mM with good reproducibility and high sensitivity (204.85 μA mM⁻¹ cm⁻²) for paraquat detection at room temperature. The PbO-NPs/SPE sensor shows high selectivity to paraquat over other popular herbicides such as glyphosate, glufosinate-ammonium and butachlor-propanil. The application of the PbO-NPs/SPE sensor is also demonstrated via the monitoring of paraquat contamination in juice and milk.

The PbO nanoparticles-based electrochemical sensor can be integrated into a smartphone for on-site field testing of paraquat with high sensitivity and selectivity.