Yamamoto I, Saito T, Harunari N, Sato Y, Kato H, Nakagawa Y, Inokuchi S, Sawada Y, Makuuchi H. Correlating the severity of paraquat poisoning with specific hemodynamic and oxygen metabolism variables.
Crit Care Med 2000;
28:1877-83. [PMID:
10890636 DOI:
10.1097/00003246-200006000-00032]
[Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE
To investigate the hemodynamics and oxygen metabolism of patients with varying degrees of severity of paraquat poisoning.
DESIGN
Prospective, observational, clinical study.
SETTING
Intensive care unit in a university hospital.
PATIENTS
Forty-three consecutive patients with paraquat and/or diquat poisoning were classified into three groups by the severity index of paraquat poisoning (SIPP; hr/mg/L).
INTERVENTIONS
Standard treatments included specific respiratory management, fluid resuscitation, and aggressive circulatory support.
MEASUREMENTS AND MAIN RESULTS
Serum paraquat and diquat levels were measured at arrival, and SIPP was calculated. The cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance index (SVRI), oxygen delivery index (DO2I), oxygen consumption index (VO2I), and oxygen extraction ratio (O2ER) were measured at 6, 12, 24, 36, 48, 72, and 96 hrs postadmission. A significant inverse correlation between SIPP and survival time was found in 31 fatal cases (r = .85; p < .001). In the SIPP 10-50 group, CI, DO2I, VO2I, and O2ER were maintained at higher levels than in the SIPP group of <10 (p < .05), whereas SVRI decreased significantly (p < .05). In the SIPP group of >50, CI, LVSWI, SVRI, DO2I, and VO2I decreased, whereas O2ER had a tendency to increase progressively. There was a significant correlation between SVRI and SIPP, O2ER and SIPP, and O2ER and SVRI 24 hrs after admission, respectively (p < .001).
CONCLUSIONS
Paraquat poisoning is characterized by high oxygen consumption with high oxygen extraction, with the degree of derangement based on the severity index. The development of a marked imbalance between increased oxygen demand and decreased oxygen supply because of myocardial depression might be a possible cause of death in circulatory failure.
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