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Zhang Y, Hou L, Yuan D, Wu J, Wang Y, Yu Y, Meng C, Yang F, Yan H, Du Y, Zhu H, Walline JH, Jiang Y, Gao Y, Li Y. Liver injury in paraquat poisoning: A retrospective cohort study. Liver Int 2024. [PMID: 38963300 DOI: 10.1111/liv.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND AND AIMS Liver injury is one of the common complications of paraquat (PQ) poisoning, but whether the degree of liver injury is related to patient prognosis is still controversial. This study aimed to investigate whether liver injury was a risk factor for death in PQ-poisoned patients. METHODS We conducted a retrospective cohort study of PQ-poisoned patients from the past 10 years (2011-2020) from a large tertiary academic medical centre in China. PQ-poisoned patients were divided into a normal liver function group (n = 580) and a liver injury group (n = 60). Propensity score matching (PSM) analysis was then performed. RESULTS A total of 640 patients with PQ poisoning were included in this study. To reduce the impact of bias, dose of PQ, urinary PQ concentration and time from poisoning to hospital admission were matched between the two groups. A 3:1 PSM analysis was performed, ultimately including 240 patients. Compared with the normal liver function group, patients in the liver injury group were older, had a higher R value ([ALT/ULN]/[ALP/ULN]) (p < .001) and had a higher mortality rate. Cox regression analysis showed that there was no significant association between alanine aminotransferase, alkaline phosphatase, total bilirubin levels and hazard of death, but age, PQ dose, creatine kinase isoenzyme, creatine kinase, white blood cell count, neutrophil percentage and lymphocyte percentage were associated with mortality in patients with PQ poisoning. CONCLUSIONS The occurrence of liver injury within 48 h after PQ poisoning was a risk factor for mortality, and such liver injury was likely of a hepatocellular nature. Age, PQ dose, creatine kinase isoenzyme and white blood cell count were positively correlated with mortality, while creatine kinase, percentage of neutrophils and lymphocytes were inversely correlated.
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Affiliation(s)
- Yan Zhang
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Hou
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ding Yuan
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingtao Wu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yibo Wang
- Emergency Department, The 7th People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yanwu Yu
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cuicui Meng
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Yang
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyi Yan
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqi Du
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanzhou Zhu
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Joseph H Walline
- Department of Emergency Medicine, Penn State Health, Milton S. Hershey Medical Center and The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Yong Jiang
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanxia Gao
- Department of Emergency Medicine, Medical Key Laboratory of Poisoning Diseases of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Tambuzzi S, Vacchiano L, Gentile G, Boracchi M, Zoja R, Migliorini AS. A Forensic Case of Suicide Ingestion of Paraquat Herbicide: New Histological Insights and Revision of the Literature. Am J Forensic Med Pathol 2024; 45:81-87. [PMID: 37728953 DOI: 10.1097/paf.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
ABSTRACT Paraquat (PQ) is one of the most widely used herbicides in the world, and poisoning is generally associated with accidental, suicidal, or homicidal events. Therefore, in the forensic context, PQ could be in various ways involved as a possible cause of death of a subject. However, even though its systemic toxicity is known, the biological effects exerted on individual viscera have been explored only to some extent, especially in case of victim's survival. Therefore, a case concerning a suicidal ingestion of PQ with survival of 3 days was deemed of interest. Clinical toxicological analyses confirmed acute PQ intoxication, and after the death of the victim, an autopsy was performed showing local and systemic signs of ingestion of a caustic substance. Histologic examination revealed marked cellular damage to the major viscera, particularly the gastroesophageal tract, liver, kidneys, and lungs, with initial alveolar fibrosis noted despite the patient's short survival. This finding represents a new element in the context of PQ lung injury, as it has not been previously documented in the literature. Thus, histological findings in lethal intoxications after survival can reveal specific peculiarities still unknown and, therefore, assume transversal relevance not only at forensic but also clinical level.
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Affiliation(s)
- Stefano Tambuzzi
- From the Laboratory of Forensic Histopathology and Forensic Microbiology, Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan
| | - Laura Vacchiano
- From the Laboratory of Forensic Histopathology and Forensic Microbiology, Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan
| | - Guendalina Gentile
- From the Laboratory of Forensic Histopathology and Forensic Microbiology, Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan
| | - Michele Boracchi
- From the Laboratory of Forensic Histopathology and Forensic Microbiology, Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan
| | - Riccardo Zoja
- From the Laboratory of Forensic Histopathology and Forensic Microbiology, Institute of Forensic Medicine, Department of Biomedical Sciences for Health, University of Milan
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Chen K, Li M, Tang Y, Lu Z. Mitochondrial reactive oxygen species initiate gasdermin D-mediated pyroptosis and contribute to paraquat-induced nephrotoxicity. Chem Biol Interact 2024; 390:110873. [PMID: 38237652 DOI: 10.1016/j.cbi.2024.110873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Paraquat (PQ)-induced acute kidney injury (AKI) progresses rapidly and is associated with high mortality rates; however, no specific antidote for PQ has been identified. Poor understanding of toxicological mechanisms underlying PQ has hindered the development of suitable treatments to combat PQ exposure. Gasdermin D (GSDMD), a key executor of pyroptosis, has recently been shown to enhance nephrotoxicity in drug-induced AKI. To explore the role of pyroptosis in PQ-induced AKI, the plasma membrane damage of the cells was detected by LDH release assay. Western blot was performed to detect the cleavage of GSDMD. RNA sequencing analysis was performed to explore the mechanism of PQ induced nephrotoxicity. Herein, we demonstrated that PQ could induce pyroptosis in HK-2 cells and nephridial tissues. Mechanistically, PQ initiated GSDMD cleavage, and GSDMD knockout attenuated PQ-induced nephrotoxicity in vivo. Further analysis revealed that the accumulation of mitochondrial reactive oxygen species (ROS) induced p38 activation, contributing to PQ-induced pyroptosis. Furthermore, mitoquinone, a mitochondria-targeted antioxidant, reduced mitochondrial ROS levels and inhibited pyroptosis. Collectively, these findings provide insights into the role of GSDMD-dependent pyroptosis as a novel mechanism of PQ-induced AKI.
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Affiliation(s)
- Kaiyuan Chen
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Wenzhou Key Laboratory of Emergency and Disaster Medicine, Wenzhou, 325000, China
| | - Mengxuan Li
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Wenzhou Key Laboratory of Emergency and Disaster Medicine, Wenzhou, 325000, China
| | - Yahui Tang
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Wenzhou Key Laboratory of Emergency and Disaster Medicine, Wenzhou, 325000, China.
| | - Zhongqiu Lu
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Wenzhou Key Laboratory of Emergency and Disaster Medicine, Wenzhou, 325000, China.
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Tang G, Jiang Z, Xu L, Yang Y, Yang S, Yao R. Development and validation of a prognostic nomogram for predicting in-hospital mortality of patients with acute paraquat poisoning. Sci Rep 2024; 14:1622. [PMID: 38238454 PMCID: PMC10796350 DOI: 10.1038/s41598-023-50722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024] Open
Abstract
This study aimed to develop and validate a predictive model to determine the risk of in-hospital mortality in patients with acute paraquat poisoning. This retrospective observational cohort study included 724 patients with acute paraquat poisoning whose clinical data were collected within 24 h of admission. The primary outcome was in-hospital mortality. Patients were randomly divided into training and validation cohorts (7/3 ratio). In the training cohort, the least absolute shrinkage and selection operator regression models were used for data dimension reduction and feature selection. Multivariate logistic regression was used to generate a predictive nomogram for in-hospital mortality. The prediction model was assessed for both the training and validation cohorts. In the training cohort, decreased level of consciousness (Glasgow Coma Scale score < 15), neutrophil-to-lymphocyte ratio, alanine aminotransferase, creatinine, carbon dioxide combining power, and paraquat plasma concentrations at admission were identified as independent predictors of in-hospital mortality in patients with acute paraquat poisoning. The calibration curves, decision curve analysis, and clinical impact curves indicated that the model had a good predictive performance. It can be used on admission to the emergency department to predict mortality and facilitate early risk stratification and actionable measures in clinical practice after further external validation.
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Affiliation(s)
- Guo Tang
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhen Jiang
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lingjie Xu
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ying Yang
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Sha Yang
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Rong Yao
- Emergency Medicine Laboratory and the Department of Emergency, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Asaduzzaman M, Roy S, Das Pew N, Roy AD, Kibria S, Roy RK, Alam MJ, Chakraborty SR. Paraquat induced acute kidney and lung injury with a dramatic response to methylprednisolone: A case report. Toxicol Rep 2023; 11:350-354. [PMID: 37868809 PMCID: PMC10585619 DOI: 10.1016/j.toxrep.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/24/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023] Open
Abstract
Background Paraquat poisoning is one of the leading causes of fatal poisoning in many parts of the world, especially in agricultural countries. Its high toxicity even in small amounts causes rapid damage to multiple organs, especially the kidneys, lungs, and liver, mainly through free radical-mediated injury. As no specific antidote is yet available, early diagnosis and the importance of supportive therapy are critical parts of management. Some evidence suggests a survival benefit from using immunosuppressive drugs. Case report This case presentation concerns a 15-year-old boy from a village with a history of herbicide poisoning, later confirmed to be paraquat. Despite supportive therapy her condition continued to deteriorate with features of kidney and lung damage. The patient was then treated with methylprednisolone 500 mg daily for 5 days, along with other supportive care, and has made a remarkable recovery. Conclusions High efficacy as an herbicide, availability and low cost make paraquat an easy-to-encounter poison for suicidal or accidental use. Its high fatality calls for urgent and effective strategies to save lives. Methylprednisolone may play a role in its treatment.
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Affiliation(s)
- Md Asaduzzaman
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh
| | - Soumitra Roy
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet 3100, Bangladesh
| | - Nibedita Das Pew
- Department of Pathology, Sylhet MAG Osmani Medical College, Sylhet 3100, Bangladesh
| | - Anindya Deb Roy
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh
| | - Shahrin Kibria
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh
| | - Ranjon Kumer Roy
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet 3100, Bangladesh
| | - M.M. Jahangir Alam
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet 3100, Bangladesh
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Gheshlaghi F, Haghirzavareh J, Wong A, Golshiri P, Gheshlaghi S, Eizadi-Mood N. Prediction of mortality and morbidity following paraquat poisoning based on trend of liver and kidney injury. BMC Pharmacol Toxicol 2022; 23:67. [PMID: 36068596 PMCID: PMC9450277 DOI: 10.1186/s40360-022-00609-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Paraquat is a non-selective herbicide that causes severe tissue damage in various organs including the liver and kidney. The aim of this study was to determine the trend of the liver and kidney injury in patients with paraquat poisoning. Methods This retrospective cross-sectional study was performed at the Khorshid Hospital referral poisoning emergency center. The medical records of all patients with acute paraquat poisoning admitted from March 2017 to October 2020 were reviewed. Demographic factors, liver and kidney function tests and outcomes were recorded. Patients were divided into two groups based on the outcome of mortality (death or survived). The two groups were compared in terms of changes in creatinine and liver enzymes during hospitalization. Results A significant difference in mean creatinine levels between the two groups was observed from the third day after admission. The peak median Cr was 3.5 mg/dl for deceased patients in day 6 and 1.47 mg/dl for survived patients on 4th day. Minor elevations of ALT and AST were present in those who died. Logistic regression analysis shows patients who had level of creatinine higher than normal from the 2nd to 6th day post overdose, the risk of mortality was 4.83 to 7.44 times more than patients with normal creatinine level. The mean (SD) area under the curve for outcome prediction was reported to be excellent for creatinine on the 8th day post overdose (85.7 ± 13.2). Creatinine was higher than 2 on the 8th day post ingestion and had a sensitivity 100% and specificity 85.7% for mortality prediction (P value, 0.05). Conclusions The risk of mortality secondary to paraquat ingestion was highly associated with a rise in creatinine. Minor elevations of ALT and AST were also present in those who died. The creatinine concentration on different days post overdose can be helpful in predicting the severity of poisoning especially when the serum paraquat levels are not available.
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Affiliation(s)
- Farzad Gheshlaghi
- Department of Clinical Toxicology, School of Medicine; Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamileh Haghirzavareh
- Medical Practitioner, Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anselm Wong
- Victorian Poisons Information Centre, Austin Toxicology and Emergency Department Austin Health, Heidelberg, and Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Parastoo Golshiri
- Department of Community Medicine and Family Physician, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayan Gheshlaghi
- Medical Practitioner, School of Medicine, Islamic Azad University Najafabad Branch, Isfahan, Iran.
| | - Nastaran Eizadi-Mood
- Department of Clinical Toxicology, School of Medicine; Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Song Y, Wang H, Tao YH. Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning. World J Clin Cases 2022; 10:4799-4809. [PMID: 35801032 PMCID: PMC9198859 DOI: 10.12998/wjcc.v10.i15.4799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/31/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication (APP).
AIM To optimize a predictive scoring system for mortality in children with APP.
METHODS A total of 113 children with APP from January 1, 2010 to January 1, 2020 were enrolled in this study. These patients were divided into survivors and non-survivors. We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors. The survival rates of patients with different values of the pediatric critical illness score (PCIS) were assessed using kaplan-meier survival analysis. The best scoring system was established by using the area under the receiver operating characteristic curve analysis.
RESULTS The overall mortality rate was 23.4%. All non-survivors died within 20 days; 48.1% (13/27) died within 3 days, and 70.3% (19/27) died within 7 days. Compared to survivors, the non-survivors were older, had higher white blood cell count, alanine aminotransferase (ALT), aspartate aminotransferase, serum creatinine, blood urea nitrogen, glucose, and pediatric early warning score, and had lower platelet count, albumin, Serum sodium (Na+) and PCIS. ALT and PCIS were the independent prognostic risk factors for children with APP. The survival rate of children classified as extremely critical patients (100%) was lower than that of children classified as critical (60%) or noncritical (6.7%) patients. The specificity of ALT was high (96.51%), but the sensitivity was low (59.26%). The sensitivity and specificity of ALT combined with PCIS were high, 92.59% and 87.21%, respectively. The difference in mortality was significantly higher for ALT combined with PCIS (area under the receiver operating characteristic: 0.937; 95%CI: 0.875-0.974; P < 0.05).
CONCLUSION In our study, ALT and PCIS were independent prognostic risk factors for children with APP. ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.
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Affiliation(s)
- Yue Song
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Hong Tao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, Sichuan Province, China
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Eddleston M, Nagami H, Lin CY, Davis ML, Chang SS. Pesticide use, agricultural outputs, and pesticide poisoning deaths in Japan. Clin Toxicol (Phila) 2022; 60:933-941. [PMID: 35475715 DOI: 10.1080/15563650.2022.2064868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Although pesticide poisonings occur worldwide, most high-income countries have not been severely affected. Japan is a key exception, with pesticide suicides becoming a major public health concern in the 1980s. We here report the epidemiology of lethal pesticide poisoning in Japan in relation to its pesticide regulation and agricultural output. METHODS We obtained data on pesticide registration and sales from the Japan Plant Protection Association's annual Pesticide Handbook, National Food and Agricultural Materials Inspection Center, and Food and Agriculture Organization of the United Nations. Data on deaths due to pesticide poisoning and population were obtained from Vital Statistics of Japan. We reviewed the registration status and hazard classification of pesticides in Japan and analysed the relationships between the use/sales, pesticides fatalities, and agricultural output. RESULTS Five hundred and twenty-nine pesticide active ingredients are currently registered in Japan, including four WHO hazard class IB organophosphorus and carbamate insecticides. Paraquat was registered in 1962 as a liquid SL20 formulation. In 1986, restrictions were imposed on its sale/use and a 4.3% paraquat ion/4.1% diquat ion combination product registered by ICI. There were 221 pesticide poisoning fatalities in 2019, down from 2648 in 1986, a 92% reduction over 33 years. Self-poisoning was responsible for most pesticide deaths in both 1985 (2013/2476, 81.3%) and 2019 (146/221, 66.1%). Pesticide poisoning made up 8.6% of all suicides in 1985, down to 0.7% in 2019. Unintentional pesticide poisoning deaths also all fell by 83.8%, from 463 to 75. These reductions were associated with reduced sales of both OP/carbamate insecticides and paraquat/diquat but no apparent change in agricultural output across a broad range of crops. CONCLUSIONS Reduced use of highly hazardous pesticides and lowered concentration formulations in Japan were associated with major decreases in all deaths from pesticide poisoning and the proportion of all suicides due to pesticide ingestion.
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Affiliation(s)
- Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Hiroshi Nagami
- Institute for Prevention of Pesticide Adverse Effects on Human, Yamatokohriyama, Japan
| | - Chien-Yu Lin
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mark L Davis
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Jia C, Zhang Z, Wang J, Nie Z. Silymarin protects the rats against paraquat-induced acute kidney injury via Nrf2. Hum Exp Toxicol 2022; 41:9603271221074334. [PMID: 35128959 DOI: 10.1177/09603271221074334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Paraquat (PQ) poisoning induces severe acute kidney injury and causes extremely high rate of death. In this study, we aimed to investigate the protective effects of silymarin on PQ-induced acute kidney injury and explore the underlying mechanisms. METHODS A rat model was established through intraperitoneal injection of PQ. Rats were administrated with saline or silymarin for 3 days. Then, survival rate, physiological parameters, and renal injury score were evaluated. The apoptosis and oxidative stress in kidney tissues were determined through hematoxylin and eosin staining, quantitative reverse transcription polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assays. RESULTS Silymarin administration could significantly increase the survival rate of PQ-poisoned rats. It was found that silymarin treatment improved renal function, decreased injury score in kidney tissues, and inhibited the apoptosis and oxidative stress in PQ-induced acute kidney injury through the activating the signaling pathway of Nrf2 and promoting its nuclear translocation. CONCLUSION Silymarin exhibited a protective effect against PQ-induced kidney injury, suggesting that treatment with this flavonoid could be a potential therapeutic agent for the treatment of acute kidney injury.
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Affiliation(s)
- C Jia
- Department of Emergency, 585241Xingtai People's Hospital of Hebei Province, Xingtai, China
| | - Z Zhang
- Department of Emergency, 585241Xingtai People's Hospital of Hebei Province, Xingtai, China
| | - J Wang
- Department of Emergency, 585241Xingtai People's Hospital of Hebei Province, Xingtai, China
| | - Z Nie
- Department of Emergency, 585241Xingtai People's Hospital of Hebei Province, Xingtai, China
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10
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Qi M, Wang N, Xiao Y, Deng Y, Zha A, Tan B, Wang J, Yin Y, Liao P. Ellagic acid ameliorates paraquat-induced liver injury associated with improved gut microbial profile. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 293:118572. [PMID: 34838710 DOI: 10.1016/j.envpol.2021.118572] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
Paraquat, a widely used herbicide, causes environmental pollution, and liver injury in humans and animals. As a natural compound in fruits, ellagic acid (EA) shows anti-inflammatory and antioxidant effects. This study examines the beneficial effects of dietary EA against the paraquat-induced hepatic injury and further explores the underlying molecular mechanisms using a piglet model. Post-weaning piglets are fed basal diet supplemented with 50 mg/kg, 100 mg/kg, or 200 mg/kg EA for 3 weeks. At week 2, hepatic injury is induced by 4 mg/kg paraquat followed by 7 days recovery. EA supplementation significantly mitigates paraquat-induced hepatic fibrosis, steatosis, and high apoptotic rate. In agreement, EA supplementation reduces serum pro-inflammatory levels, ameliorates inflammatory cells infiltration into hepatic tissue, which are associated with suppressed NF-κB signaling during paraquat exposure. In addition, EA supplementation significantly improves activities of antioxidative enzymes which were correlated with activated Nrf2/Keap 1 signaling during paraquat exposure. Furthermore, EA supplementation restores cecal microbial community during paraquat exposure. The protective effect of EA is strongly linked with increased relative abundance of Lactobacillus reuteri and Lactobacillus amylovorus. Taken together, EA supplementation effectively reduced the occurrence of hepatic oxidative damage and inflammation induced by paraquat through modulating cecal microbial communities, which provides a novel nutritional therapeutic strategy for hepatic injury.
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Affiliation(s)
- Ming Qi
- National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Key Laboratory of Agro-ecological Processes in Subtropical Region, Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, Hunan, China; College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China; University of Chinese Academy of Sciences, Beijing, 100008, China
| | - Nan Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China
| | - Yuxin Xiao
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China
| | - Yuankun Deng
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China
| | - Andong Zha
- National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Key Laboratory of Agro-ecological Processes in Subtropical Region, Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, Hunan, China; University of Chinese Academy of Sciences, Beijing, 100008, China
| | - Bie Tan
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China
| | - Jing Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China.
| | - Yulong Yin
- National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Key Laboratory of Agro-ecological Processes in Subtropical Region, Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, Hunan, China; College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410000, Hunan, China; University of Chinese Academy of Sciences, Beijing, 100008, China
| | - Peng Liao
- National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Key Laboratory of Agro-ecological Processes in Subtropical Region, Laboratory of Animal Nutritional Physiology and Metabolic Process, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, Hunan, China; University of Chinese Academy of Sciences, Beijing, 100008, China
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11
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Liu Z, Huang F, Zhao S, Ma L, Shi Q, Zhou Y. Homicidal paraquat poisoning: Poisoned while drinking. J Forensic Sci 2022; 67:1312-1319. [PMID: 35005788 DOI: 10.1111/1556-4029.14968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/31/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
The incidence of paraquat poisoning has significantly decreased with the addition of odorizer and emetics to the liquid concentrate. Paraquat poisonings are usually attributed to suicidal and accidental or occupational exposure. Here, we report an unusual fatal case of homicidal paraquat poisoning. An intoxicated, a 37-year-old man consumed a mixture of white wine and paraquat prepared by his wife. This resulted in intermittent vomiting, which he attributed to being intoxicated. The man was admitted to the hospital for treatment 3 days later. Due to the lack of knowledge of paraquat exposure, the man did not receive effective treatment and died of respiratory failure 22 days later. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was applied to detect paraquat in 16 postmortem specimens: kidney (1.31 ug/g), urine (0.91 ug/ml), liver (0.62 ug/g), lung (0.39 ug/g), muscle (0.35 ug/g), bile (0.32 ug/ml), heart (0.28 ug/g), brain (0.22 ug/g), pancreas (0.22 ug/g), spleen (0.18 ug/g), cardiac blood (0.15 ug/ml), cerebrospinal fluid (0.14 ug/ml), pericardial effusion (0.12 ug/ml), pleural effusion (0.09 ug/ml), peripheral blood (0.08 ug/ml), and vitreous humor (0.06 ug/ml). The highest concentration of paraquat was detected in the kidney followed by the urine in all tissues and body fluids. At present, although the cases of paraquat poisoning have decreased, the high mortality rate resulting from its irreversible lung damage and respiratory failure makes paraquat poisoning, especially occult paraquat poisoning, still needs to be carefully identified in forensic practice and clinical diagnosis.
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Affiliation(s)
- Zihao Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longda Ma
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Shi
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Tang Y, Chen H, Qiu W, Zhou Y, Hong G, Hu L, Zhao G, Chen X, Zhi S, Lu Z. Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients. Ther Drug Monit 2021; 43:797-806. [PMID: 34780392 DOI: 10.1097/ftd.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paraquat ( PQ) is very poisonous to humans and animals and there is no effective clinical antidote . The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies. METHODS The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by high-performance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed. RESULTS Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50-1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was <516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was <516 ng/mL in the death group was only 19%. CONCLUSIONS The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.
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Affiliation(s)
- Yahui Tang
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Hui Chen
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Weiyong Qiu
- Department of Intensive Care Medicine, Yiwu Hospital Affiliated to Wenzhou Medical University
| | - Yanxue Zhou
- Department of Nephrology, Yiwu Hospital Affiliated to Wenzhou Medical University, Yiwu; and
| | - Guangliang Hong
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Lufeng Hu
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guangju Zhao
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Xiaorong Chen
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Shaoce Zhi
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Zhongqiu Lu
- Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
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13
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Successful treatment of severe toxic hepatitis and encephalopathy without respiratory failure caused by paraquat intoxication. Am J Med Sci 2021; 363:267-272. [PMID: 34793708 DOI: 10.1016/j.amjms.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/19/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022]
Abstract
Lung damage is a characteristic feature of paraquat intoxication; most deaths resulting from ingesting paraquat are due to progressive respiratory failure. Liver failure caused by paraquat intoxication is rare. A case of orally ingested paraquat intoxication is reported in which serious liver injury and toxic encephalopathy were observed, but little lung damage was found. The principal systemic symptom was severe liver injury, characterized by cholestasis, that gradually became aggravated. In addition to standard treatment, aggressive treatment through liver protection and cholestasis was administered. Finally, liver function returned to normal and central nervous system symptoms were controlled. The patient was successfully discharged. This case suggests that the hepatotoxicity of paraquat intoxication is possibly characterized by cholestasis, and the treatment of cholestasis promotes recovery of severe hepatocyte damage.
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14
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Asaduzzaman M, Chando MR, Ahmed N, Rezwanul Islam KM, Alam MMJ, Roy S. Paraquat-induced acute kidney and liver injury: Case report of a survivor from Bangladesh. Clin Case Rep 2021; 9:e05020. [PMID: 34765204 PMCID: PMC8572334 DOI: 10.1002/ccr3.5020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
Despite high fatality following paraquat ingestion, a few percentages of patients survive even after organ damage appears. We need to focus more on careful clinical and laboratory monitoring. Early diagnosis and Supportive therapy are crucial.
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Affiliation(s)
- Md Asaduzzaman
- Department of MedicineSylhet M.A.G Osmani Medical College HospitalSylhetBangladesh
| | | | - Nasad Ahmed
- Department of MedicineSylhet M.A.G Osmani Medical College HospitalSylhetBangladesh
| | | | | | - Soumitra Roy
- Department of MedicineSylhet M.A.G Osmani Medical College HospitalSylhetBangladesh
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15
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Anthrahydroquinone-2-6-disulfonate is a novel, powerful antidote for paraquat poisoning. Sci Rep 2021; 11:20159. [PMID: 34635711 PMCID: PMC8505516 DOI: 10.1038/s41598-021-99591-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Paraquat (PQ) is a widely used fast-acting pyridine herbicide. Accidental ingestion or self-administration via various routes can cause severe organ damage. Currently, no effective antidote is available commercially, and the mortality rate of poisoned patients is exceptionally high. Here, the efficacy of anthrahydroquinone-2-6-disulfonate (AH2QDS) was observed in treating PQ poisoning by constructing in vivo and ex vivo models. We then explored the detoxification mechanism of AH2QDS. We demonstrated that, in a rat model, the PQ concentration in the PQ + AH2QDS group significantly decreased compared to the PQ only group. Additionally, AH2QDS protected the mitochondria of rats and A549 cells and decreased oxidative stress damage, thus improving animal survival and cell viability. Finally, the differentially expressed genes were analysed in the PQ + AH2QDS group and the PQ group by NextGen sequencing, and we verified that Nrf2's expression in the PQ + AH2QDS group was significantly higher than that in the PQ group. Our work identified that AH2QDS can detoxify PQ by reducing PQ uptake and protecting mitochondria while enhancing the body's antioxidant activity.
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16
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Chen J, Su Y, Lin F, Iqbal M, Mehmood K, Zhang H, Shi D. Effect of paraquat on cytotoxicity involved in oxidative stress and inflammatory reaction: A review of mechanisms and ecological implications. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 224:112711. [PMID: 34455184 DOI: 10.1016/j.ecoenv.2021.112711] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
Paraquat (PQ) is a cheap and an effective herbicide, which is widely being used worldwide to remove weeds in cultivated crop fields. However, it can cause soil and water pollution, and pose serious harm to the environment and organisms. Several countries have started to limit or prohibit the use of PQ because of the increasing number of human deaths. Its toxicity can damage the organisms with a multi-target mechanism, which has not been fully understood yet. That is why it is hard to treat as well. The current research on PQ focuses on its targeted organ, the lungs, in which PQ mostly trigger pulmonary fibrosis. While there is a lack of systematic research, there are few studies published discussing its toxic effects at systematic level. This review summarizes the major damages caused by PQ in different organisms and partial mechanisms by which it causes these damages. For this purpose, we consulted several research articles that studied the toxicity of PQ in various tissues. We also listed some drugs that can be used to alleviate the toxicity of PQ. However, at present, the effectiveness of these drugs is still being explored in animal experiments and the study of their mechanism will also help in understanding the poisoning mechanism of PQ, which will ultimately lead to effective treatment in future.
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Affiliation(s)
- Jiaxin Chen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Yalin Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Fei Lin
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Mujahid Iqbal
- Department of Pathology, Cholistan University of Veterinary and Animal Sciences (CUVAS), Bahawalpur 63100, Pakistan
| | - Khalid Mehmood
- Department of Clinical Medicine and Surgery, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, 63100, Pakistan
| | - Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
| | - Dayou Shi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
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17
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Zheng Q, Zhang Y, Zhao Z, Shen H, Zhao H, Zhao M. Isorhynchophylline ameliorates paraquat-induced acute kidney injury by attenuating oxidative stress and mitochondrial damage via regulating toll-interacting expression. Toxicol Appl Pharmacol 2021; 420:115521. [PMID: 33838153 DOI: 10.1016/j.taap.2021.115521] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 01/13/2023]
Abstract
Isorhynchophylline (IRN) is an alkaloid with anti-inflammatory and anti-oxidative activities in cardiovascular and brain diseases, but its role in paraquat (PQ)-induced acute kidney injury (AKI) is yet unknown. The model of PQ-induced AKI in rats was established by intraperitoneal injection of PQ (25 mg/kg). We found that the tail vein injection of IRN (4 mg/kg) significantly increased the survival rate of PQ-intoxicated rats. IRN administration alleviated PQ-induced renal injury and renal dysfunction in rats, as evidenced by decreased apoptosis in renal cortex and reduced serum creatinine, serum BUN, and urine NGAL levels. Furthermore, IRN treatment improved the PQ-triggered oxidative stress in renal cortex by increasing the levels of anti-oxidant indicators (SOD activity, GSH/GSSG ratio, levels of Nrf-2, NQO-1, and HO-1 in renal cortex) and decreasing the levels of oxidative stress indexes (ROS and MDA levels in renal cortex). Interestingly, toll-interacting protein (Tollip), a negative regulator of interleukin 1 receptor associated kinase 1 (IRAK1) phosphorylation, was demonstrated to be increased by IRN injection in the renal cortex of PQ-intoxicated rats. In vitro experiments revealed that IRN protected renal tubular epithelial cells against PQ toxicity through suppressing oxidative stress and mitochondrial damage, and these protective effects were reversed by Tollip shRNA. Collectively, the present study demonstrated that IRN ameliorated PQ-induced AKI by attenuating oxidative stress and mitochondrial damage through upregulating Tollip, which provides new insights into the pathogenesis and treatment of PQ poisoning.
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Affiliation(s)
- Qiang Zheng
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yuan Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zheng Zhao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Haitao Shen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Hongyu Zhao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Min Zhao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
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18
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Sahoo D, Kar N, Devi S, Dey A, Das DS. A Case of Paraquat Poisoning Presenting With Spontaneous Pneumothorax and Pneumomediastinum. Cureus 2020; 12:e11943. [PMID: 33425522 PMCID: PMC7785492 DOI: 10.7759/cureus.11943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paraquat (1,1’-dimethyl-4,4’-dipyridylium) is a liquid herbicide associated with accidental and suicidal ingestion, leading to fatal toxicity. It can lead to multiple organ dysfunction, including metabolic acidosis, acute kidney and liver injury, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). Very rarely, this can present with spontaneous pneumothorax or pneumomediastinum or both, which are poor prognostic markers with a mortality rate of almost 100%. Here, we present a young male presenting with paraquat poisoning followed by the development of both pneumothorax and pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence.
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19
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Chen AB, Li F, Di EM, Zhang X, Zhao QY, Wen J. Influence of strengthened hemoperfusion combined with continuous venovenous hemofiltration on prognosis of patients with acute paraquat poisoning: SHP + CVVH improve prognosis of acute PQ patients. BMC Pharmacol Toxicol 2020; 21:49. [PMID: 32631415 PMCID: PMC7339412 DOI: 10.1186/s40360-020-00428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background The success rate of rescue is extremely low in acute paraquat poisoning. This study aimed to assess whether strengthened hemoperfusion (SHP) combined with continuous venovenous hemofiltration (CVVH) improves prognosis in patients with acute paraquat poisoning. Methods Patients from January 2005 to December 2018 were enrolled retrospectively. All selected patients were administered conventional therapy. They were divided according to the received treatments in the conventional therapy, hemoperfusion (HP), CVVH, SHP and SHP + CVVH groups. Follow-up was implemented until the 90th day after poisoning. Other outcomes included all-cause mortality on the 15th day after poisoning, and the percentages of respiratory failure and mechanical ventilation use. Results The study included 487 patients,and 211 died in all. Mortality rate in the SHP + CVVH group on the 90th day after poisoning was significantly decreased compared with those of other groups (p<0.001). Survival curves of all groups showed significant differences (p<0.001). SHP combined with CVVH was an independent factor reducing mortality risk (p<0.001). Mortality rate in the SHP + CVVH group on the 15th day after poisoning was also significantly decreased (p < 0.05). The proportions of patients in the SHP + CVVH group with acute respiratory failure and mechanical ventilation were significantly lower than those of other groups (p < 0.05). Conclusions SHP with CVVH may decrease the mortality rate of patients with acute paraquat poisoning on the 90th day after poisoning and improve the prognosis.
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Affiliation(s)
- An-Bao Chen
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang Li
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - E-Mu Di
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiao Zhang
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qun-Yuan Zhao
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Wen
- Department of Emergency Medicine, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
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20
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Osteonecrosis of Femoral Head, An Overlooked Long-Term Complication after Paraquat Intoxication: A Retrospective Cohort Study. Sci Rep 2020; 10:8827. [PMID: 32483235 PMCID: PMC7264308 DOI: 10.1038/s41598-020-65756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/29/2020] [Indexed: 01/04/2023] Open
Abstract
With increasing numbers of patients surviving acute intoxication phase, long-term complication after paraquat intoxication is a topic worth exploring, such as osteonecrosis (ON) of femoral head. We reviewed 86 paraquat-intoxicated survivors between 2000 and 2012 in Chang Gung Memorial Hospital, a 3700-bed tertiary hospital in Taiwan. With all the patients underwent same detoxification protocol in the acute stage, 17.4% of paraquat poisoning survivors developed ON of femoral head requiring surgery during follow up. Most of ON episodes occurred within 2 to 4 years after paraquat intoxication and then plateau after 6 years. ON patients exhibited higher SOFA scores than non-ON patients (2.80 ± 2.14 vs. 1.76 ± 1.52, p = 0.028). Furthermore, AKIN scores are also higher in the ON patients than non-ON patients (0.87 ± 1.13 vs. 0.38 ± 0.74, p = 0.040). Multivariate logistic regression showed higher AKIN score and higher partial pressure of carbon dioxide in the blood 48 hours after admission significantly predicted ON of femoral head after paraquat intoxication (p = 0.002 and p = 0.006 respectively). Larger studies with longer follow-up durations are warranted to confirm our finding.
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21
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Hydrogen Sulfide Protects against Paraquat-Induced Acute Liver Injury in Rats by Regulating Oxidative Stress, Mitochondrial Function, and Inflammation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6325378. [PMID: 32064027 PMCID: PMC6998754 DOI: 10.1155/2020/6325378] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022]
Abstract
In addition to the lung, the liver is considered another major target for paraquat (PQ) poisoning. Hydrogen sulfide (H2S) has been demonstrated to be effective in the inhibition of oxidative stress and inflammation. The aim of this study was to investigate the protective effect of exogenous H2S against PQ-induced acute liver injury. The acute liver injury model was established by a single intraperitoneal injection of PQ, evidenced by histological alteration and elevated serum aminotransferase levels. Different doses of NaHS were administered intraperitoneally one hour before exposure to PQ. Analysis of the data shows that exogenous H2S attenuated the PQ-induced liver injury and oxidative stress in a dose-dependent manner. H2S significantly suppressed reactive oxygen species (ROS) generation and the elevation of malondialdehyde content while it increased the ratio of GSH/GSSG and levels of antioxidant enzymes including SOD, GSH-Px, HO-1, and NQO-1. When hepatocytes were subjected to PQ-induced oxidative stress, H2S markedly enhanced nuclear translocation of Nrf2 via S-sulfhydration of Keap1 and resulted in the increase in IDH2 activity by regulating S-sulfhydration of SIRT3. In addition, H2S significantly suppressed NLRP3 inflammasome activation and subsequent IL-1β excretion in PQ-induced acute liver injury. Moreover, H2S cannot reverse the decrease in SIRT3 and activation of the NLRP3 inflammasome caused by PQ in Nrf2-knockdown hepatocytes. In summary, H2S attenuated the PQ-induced acute liver injury by enhancing antioxidative capability, regulating mitochondrial function, and suppressing ROS-induced NLRP3 inflammasome activation. The antioxidative effect of H2S in PQ-induced liver injury can at least partly be attributed to the promotion of Nrf2-driven antioxidant enzymes via Keap1 S-sulfhydration and regulation of SIRT3/IDH2 signaling via Nrf2-dependent SIRT3 gene transcription as well as SIRT3 S-sulfhydration. Thus, H2S supplementation can form the basis for a promising novel therapeutic strategy for PQ-induced acute liver injury.
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22
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Song Y, Li C, Luo F, Tao Y. Clinical features and risk factors of acute kidney injury in children with acute paraquat intoxication. J Int Med Res 2019; 47:4194-4203. [PMID: 31304846 PMCID: PMC6753536 DOI: 10.1177/0300060519860032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study aimed to investigate the clinical features and risk factors of
acute kidney injury (AKI) in children with acute paraquat intoxication. Methods A retrospective study of 110 hospitalized children with acute paraquat
intoxication in West China Second University Hospital, Sichuan University
was conducted from January 2010 to May 2017. The Kaplan–Meier method was
used to compare the survival rates of children with different AKI stages.
Multivariate logistic regression was applied to analyse the risk factors for
paraquat-induced AKI. Results AKI occurred in 42 of 110 (38.2%) children. We observed AKI stage 1 in two
(4.8%) children, AKI stage 2 in 11 (26.2%), and AKI stage 3 in 29 (69.0%).
The survival rate of children in AKI stage 3 (34.5%) was significantly lower
than that in children in AKI stage 2 (63.6%) and AKI stage 1 (100%).
Multivariate analysis showed that oral ulcers and elevated blood glucose
levels were significant independent risk factors for paraquat-induced AKI in
children (odds ratio = 4.223 and 5.545, respectively). Conclusions The incidence and mortality rates of paraquat-induced AKI in children are
high. Oral ulcers and elevated blood glucose levels are independent risk
factors affecting the occurrence of paraquat-induced AKI in children.
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Affiliation(s)
- Yue Song
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Chaofeng Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fenglan Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuhong Tao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Sharma DS, Prajapati AM, Shah DM. Review of a Case of Paraquat Poisoning in a Tertiary Care Rural-based ICU. Indian J Crit Care Med 2019; 23:284-286. [PMID: 31435149 PMCID: PMC6698351 DOI: 10.5005/jp-journals-10071-23182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Paraquat (1,1′-dimethyl-4, 4′-dipyridylium) is a broad-spectrum liquid herbicide associated with both accidental and intentional ingestion leading to severe and often fatal toxicity.1 Paraquat is actively taken up against a concentration gradient into lung tissue leading to pneumonitis and lung fibrosis. Paraquat also causes renal and liver injury.2 There are few case publications of paraquat poisoning and only few of them have reported that renal failure has ensued before acute respiratory distress syndrome (ARDS). Our patient presented with above lethal dose intake of paraquat containing substance and we did gastric lavage followed by charcoal hemoperfusion and hemodialysis but patient could not be saved despite optimum efforts suggesting the high fatality of this kind of poisoning.
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Affiliation(s)
- Deepak S Sharma
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Abhishek M Prajapati
- Department of Critical Care, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Dhruv M Shah
- Department of Critical Care, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
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Shadnia S, Ebadollahi-Natanzi A, Ahmadzadeh S, Karami-Mohajeri S, Pourshojaei Y, Rahimi HR. Delayed death following paraquat poisoning: three case reports and a literature review. Toxicol Res (Camb) 2018; 7:745-753. [PMID: 30310653 PMCID: PMC6116805 DOI: 10.1039/c8tx00120k] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022] Open
Abstract
Paraquat (PQ) poisoning is principally reported in developing countries. However, most fatalities occur elsewhere due to the induction of multi-organ failure. PQ poisoning can hardly be managed by clinical practice, and no specific antidote has come into existence yet. Here three cases, including 17-, 20-, and 23-year-old men, who were poisoned with PQ, have been reported. Furthermore, the literature regarding biological mechanisms, clinical manifestation, and treatment of PQ-induced toxicity was reviewed. Patients who, either intentionally or accidentally, ingested PQ earlier were initially found to be stable at the emergency department (ED). Therefore, they were discharged from the hospital under a follow-up. However, after several days, the patients were referred to the hospital for the second time and despite cardiovascular resuscitation (CPR) efforts, they suddenly expired. The delayed death following exposure to PQ was reported for inducing gradual progressive pulmonary fibrosis, metabolic acidosis, neurotoxicity, renal failure, and liver injury in poisoned patients. Therefore, PQ-intoxicated patients should be supervised for up to several weeks, and kept in the hospital for a longer period of time. Clinical manifestations and laboratory findings are beneficial markers that act as useful predictors of PQ poisoning.
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Affiliation(s)
- Shahin Shadnia
- Toxicology Research Center , Excellence Center of Clinical Toxicology , Department of Clinical Toxicology , Loghman Hakim Hospital , School of Medicine , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Alireza Ebadollahi-Natanzi
- Medicinal Plants Department , Imam Khomeini Higher Education Center , Agricultural Research , Education and Extension Organization (AREEO) , Karaj , Iran
| | - Saeid Ahmadzadeh
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
| | - Somayyeh Karami-Mohajeri
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Yaghoub Pourshojaei
- Department of Medicinal Chemistry , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Hamid Reza Rahimi
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
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Kuo FC, Wu MR, Hsiao CY, Chen CY, Wang KT, Yeh HI, Su MI. Palliative Care on Patients With Paraquat Poisoning: Analysis of 90 Cases From 2005–2016. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Wu MR, Hsiao CY, Cheng CH, Liao FC, Chao CL, Chen CY, Yeh HI, Su MI. Is endotracheal intubation a non-beneficial treatment in patients with respiratory failure due to paraquat poisoning? PLoS One 2018; 13:e0195071. [PMID: 29590187 PMCID: PMC5874070 DOI: 10.1371/journal.pone.0195071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/18/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction Paraquat poisoning can result in dysfunction of multiple organs, and pulmonary fibrosis with respiratory failure is the major cause of mortality. For terminally ill patients, some life-prolonging treatments can be non-beneficial treatments (NBT). The objective of this study was to determine if intubation is a NBT for patients with respiratory failure due to paraquat poisoning. Methods The study included 68 patients with respiratory failure due to paraquat poisoning. Patients were hospitalized at MacKay Memorial Hospital, Taitung Branch, Taiwan, between 2005 to April 2016. Composite outcomes of intra-hospital mortality, the rate of do-not-resuscitate (DNR) orders, prescribed medications, length of stay, and medical costs were recorded and compared between the do-not-intubate (DNI) group and endotracheal intubation (EI) group. Results Intra-hospital mortality rate for the entire population was 100%. There were significantly more patients with DNR orders in the DNI group (P = 0.007). There were no differences in the length of hospital stay. However, patients in DNI group had significantly less vasopressor use and more morphine use, shorter time in the intensive care unit, and fewer medical costs. Conclusion The procedure of intubation in patients with respiratory failure due to paraquat poisoning can be considered inappropriate life-prolonging treatment.
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Affiliation(s)
- Meng-Ruey Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
| | - Chia-Ying Hsiao
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
| | - Chun-Han Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
| | - Feng-Ching Liao
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
| | - Chuan-Lei Chao
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
| | - Chun-Yen Chen
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
| | - Min-I Su
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung branch, Taiwan
- MacKay Medical College, New Taipei City, Taiwan
- * E-mail:
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Wei TY, Yen TH, Cheng CM. Point-of-care testing in the early diagnosis of acute pesticide intoxication: The example of paraquat. BIOMICROFLUIDICS 2018; 12:011501. [PMID: 29430271 PMCID: PMC5775096 DOI: 10.1063/1.5003848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/04/2018] [Indexed: 05/09/2023]
Abstract
Acute pesticide intoxication is a common method of suicide globally. This article reviews current diagnostic methods and makes suggestions for future development. In the case of paraquat intoxication, it is characterized by multi-organ failure, causing substantial mortality and morbidity. Early diagnosis may save the life of a paraquat intoxication patient. Conventional paraquat intoxication diagnostic methods, such as symptom review and urine sodium dithionite assay, are time-consuming and impractical in resource-scarce areas where most intoxication cases occur. Several experimental and clinical studies have shown the potential of portable Surface Enhanced Raman Scattering (SERS), paper-based devices, and machine learning for paraquat intoxication diagnosis. Portable SERS and new SERS substrates maintain the sensitivity of SERS while being less costly and more convenient than conventional SERS. Paper-based devices provide the advantages of price and portability. Machine learning algorithms can be implemented as a mobile phone application and facilitate diagnosis in resource-limited areas. Although these methods have not yet met all features of an ideal diagnostic method, the combination and development of these methods offer much promise.
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Affiliation(s)
- Ting-Yen Wei
- Interdisciplinary Program of Life Science, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and Chang Gung University, Linkou 333, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan
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Weng CH, Chen HH, Hu CC, Huang WH, Hsu CW, Fu JF, Lin WR, Wang IK, Yen TH. Predictors of acute kidney injury after paraquat intoxication. Oncotarget 2017; 8:51345-51354. [PMID: 28881652 PMCID: PMC5584253 DOI: 10.18632/oncotarget.17975] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO2 (P = 0.006) and higher alveolar-arterial O2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO2 at admission (P = 0.031), higher PaO2 at admission (P = 0.015), lower nadir PaCO2 (P = 0.001) and lower nadir HCO3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Hui-Hsiang Chen
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Jen-Fen Fu
- Department of Medical Research, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - I-Kwan Wang
- Department of Nephrology, Chang Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Poison Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.,Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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Liu XW, Ma T, Li LL, Qu B, Liu Z. Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning. Exp Ther Med 2017; 14:79-86. [PMID: 28672896 PMCID: PMC5488431 DOI: 10.3892/etm.2017.4463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 02/14/2017] [Indexed: 12/12/2022] Open
Abstract
The present study investigated the predictive values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and Acute Physiology and Chronic Health Evaluation (APACHE) II score in the prognosis of patients with acute PQ poisoning. A total of 194 patients with acute PQ poisoning, hospitalized between April 2012 and January 2014 at the First Affiliated Hospital of P.R. China Medical University (Shenyang, China), were selected and divided into survival and mortality groups. Logistic regression analysis, receiver operator characteristic (ROC) curve analysis and Kaplan-Meier curve were applied to evaluate the values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and (APACHE) II score for predicting the prognosis of patients with acute PQ poisoning. Initial urine PQ concentration (C0), dose of poison, arterial blood lactate and APACHE II score of patients in the mortality group were significantly higher compared with the survival group (all P<0.05). Logistic regression analysis revealed that C0, dose of poison and arterial blood lactate correlated with mortality risk of acute PQ poisoning (all P<0.05). ROC curve analysis suggested that the areas under the curve (AUC) values of C0, dose of poison, arterial blood lactate and APACHE II score in predicting the mortality of patients within 28 days were 0.921, 0.887, 0.808 and 0.648, respectively. The AUC of C0 for predicting early and delayed mortality were 0.890 and 0.764, respectively. The AUC values of urine paraquat concentration the day after poisoning (Csec) and the rebound rate of urine paraquat concentration in predicting the mortality of patients within 28 days were 0.919 and 0.805, respectively. The 28-day survival rate of patients with C0 ≤32.2 µg/ml (42/71; 59.2%) was significantly higher when compared with patients with C0 >32.2 µg/ml (38/123; 30.9%). These results suggest that the initial urine PQ concentration may be the optimal index for predicting the prognosis of patients with acute PQ poisoning. Additionally, dose of poison, arterial blood lactate, Csec and rebound rate also have referential significance.
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Affiliation(s)
- Xiao-Wei Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Tao Ma
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Lu-Lu Li
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Bo Qu
- Department of Biostatistics, School of Public Health, China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Zhi Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Safaei Asl A, Dadashzadeh P. Acute kidney injury in patients with paraquat intoxication; a case report and review of the literature. J Renal Inj Prev 2016; 5:203-6. [PMID: 27689124 PMCID: PMC5039990 DOI: 10.15171/jrip.2016.43] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/09/2016] [Indexed: 11/09/2022] Open
Abstract
Paraquat and diquat are classified as bipyridyl compounds not only leads to acute organ damage, but also to a variety of complications. Patients with severe paraquat-induced poisoning may succumb to multiple organ failure involving the circulatory and respiratory systems. Deliberate self-poisoning with paraquat continues to be a major public health concern in many developing countries. At present there is no specific antidote to paraquat poisoning, hence the need to more focus on prevention and in cases of poisoning aggressive decontamination to prevent further absorption. This article presented a 12-year-old male with acute kidney injury following the ingestion of paraquat in suicidal attempt and serves to explore the complications associated with paraquat poisoning and current recommended treatment.
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Affiliation(s)
- Afshin Safaei Asl
- Division of Nephrology, Department of Pediatrics, Guilan University of Medical Sciences, Rasht, Iran
| | - Peyman Dadashzadeh
- Resident of Pediatrics , Guilan University of Medical Sciences, Rasht, Iran
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Rapisarda V, Loreto C, Malaguarnera M, Ardiri A, Proiti M, Rigano G, Frazzetto E, Ruggeri MI, Malaguarnera G, Bertino N, Malaguarnera M, Catania VE, Di Carlo I, Toro A, Bertino E, Mangano D, Bertino G. Hepatocellular carcinoma and the risk of occupational exposure. World J Hepatol 2016; 8:573-90. [PMID: 27168870 PMCID: PMC4858622 DOI: 10.4254/wjh.v8.i13.573] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 04/01/2016] [Accepted: 04/14/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. The main risk factors for HCC are alcoholism, hepatitis B virus, hepatitis C virus, nonalcoholic steatohepatitis, obesity, type 2 diabetes, cirrhosis, aflatoxin, hemochromatosis, Wilson's disease and hemophilia. Occupational exposure to chemicals is another risk factor for HCC. Often the relationship between occupational risk and HCC is unclear and the reports are fragmented and inconsistent. This review aims to summarize the current knowledge regarding the association of infective and non-infective occupational risk exposure and HCC in order to encourage further research and draw attention to this global occupational public health problem.
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Affiliation(s)
- Venerando Rapisarda
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Carla Loreto
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Michele Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Annalisa Ardiri
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria Proiti
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppe Rigano
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Evelise Frazzetto
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria Irene Ruggeri
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giulia Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Nicoletta Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Mariano Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Vito Emanuele Catania
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Isidoro Di Carlo
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Adriana Toro
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Emanuele Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Dario Mangano
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gaetano Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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Chen JL, Dai L, Zhang P, Chen W, Cai GS, Qi XW, Hu MZ, Du B, Pang QF. Methylene blue attenuates acute liver injury induced by paraquat in rats. Int Immunopharmacol 2015; 28:808-12. [DOI: 10.1016/j.intimp.2015.04.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 12/28/2022]
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The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One 2015; 10:e0121691. [PMID: 25830638 PMCID: PMC4382148 DOI: 10.1371/journal.pone.0121691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/14/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning. METHODS Lung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis. RESULTS Of 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and "no obvious lesion". With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001). CONCLUSIONS The volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
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Ku CH, Hung HM, Leong WC, Chen HH, Lin JL, Huang WH, Yang HY, Weng CH, Lin CM, Lee SH, Wang IK, Liang CC, Chang CT, Lin WR, Yen TH. Outcome of patients with carbon monoxide poisoning at a far-east poison center. PLoS One 2015; 10:e0118995. [PMID: 25745854 PMCID: PMC4352004 DOI: 10.1371/journal.pone.0118995] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/27/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Many cases of carbon monoxide poisoning in Taiwan are due to burning charcoal. Nevertheless, few reports have analyzed the mortality rate of these patients who survive to reach a hospital and die despite intensive treatment. Therefore, this study examined the clinical features, physiological markers, and outcomes after carbon monoxide poisoning and the associations between these findings. METHODS We analyzed the records of 261 patients who were referred for management of carbon monoxide intoxication between 2000 and 2010. Patients were grouped according to status at discharge as alive (survivor, n = 242) or dead (non-survivor, n = 19). Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS Approximately half of the cases (49.4%) attempted suicide by burning charcoal. Most of the patients were middle-aged adults (33±19 years), and were referred to our hospital in a relatively short period of time (6±10 hours). Carbon monoxide produced many serious complications after exposure: fever (26.1%), hypothermia (9.6%), respiratory failure (34.1%), shock (8.4%), myocardial infarction (8.0%), gastrointestinal upset (34.9%), hepatitis (18.4%), renal failure (25.3%), coma (18.0%) and rhabdomyolysis (21.8%). Furthermore, the non-survivors suffered greater incidences of hypothermia (P<0.001), respiratory failure (P<0.001), shock (P<0.001), hepatitis ((P=0.016), renal failure (P=0.003), coma (P<0.001) than survivors. All patients were treated with high concentration of oxygen therapy using non-rebreather mask. However, hyperbaric oxygen therapy was only used in 18.8% of the patients. In a multivariate-Cox-regression model, it was revealed that shock status was a significant predictor for mortality after carbon monoxide poisoning (OR 8.696, 95% CI 2.053-37.370, P=0.003). Finally, Kaplan-Meier analysis confirmed that patients with shock suffered greater cumulative mortality than without shock (Log-rank test, Chi-square 147.404, P<0.001). CONCLUSION The mortality rate for medically treated carbon monoxide-poisoned patients at our center was 7.3%. Furthermore, the analysis indicates that shock was most strongly associated with higher risk of mortality.
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Affiliation(s)
- Chung-Hsuan Ku
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Huei-Min Hung
- Department of Pediatrics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wa Cheong Leong
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Hsiao-Hui Chen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Che-Min Lin
- Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Chia Liang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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Muthu V, Das A, Bal A, Agarwal R. Severe cholestasis and hepatic dysfunction in a case of fatal paraquat poisoning. Clin Res Hepatol Gastroenterol 2015; 39:e7-9. [PMID: 25193237 DOI: 10.1016/j.clinre.2014.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 07/18/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lin C, Yen TH, Juang YY, Lin JL, Lee SH. Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010. PLoS One 2014; 9:e112160. [PMID: 25386676 PMCID: PMC4227688 DOI: 10.1371/journal.pone.0112160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated. METHODS We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates. RESULTS The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure. CONCLUSIONS Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Clinical characteristics of paraquat poisoning in 22 Chinese children. Indian J Pediatr 2014; 81:670-4. [PMID: 23884648 DOI: 10.1007/s12098-013-1155-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/20/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To retrospectively analyze the clinical characteristics and experience of Chinese children with paraquat poisoning. METHODS Twenty-two children with paraquat poisoning who presented to the hospital from October 2007 through September 2012 were enrolled into this study. The clinical indices of these cases were collected and analyzed. RESULTS All the children were poisoned due to oral ingestion of paraquat. Different degrees of damage were found in multiple systems in their bodies. All of them were administered pulse therapy using methylprednisolone (20 mg/kg/d × 3d) and Gamma globulin (total 2 g/kg divided into 3 d to 5 d) in the early stage. Prednisone was then given orally for 4 wk to 8 wk. The total mortality rate of the patients was 63.6 % (14 of 22 patients died). Statistical differences (P < 0.05) were found between the surviving and dead patients, with regard to age, plasma paraquat levels, the highest levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, total bilirubin, direct bilirubin, indirect bilirubin, blood urea nitrogen, creatinine and pH value, the lowest levels of PaO2, PaCO2 and SaO2. Plasma paraquat level was positively related to pH value, but was negatively related to PaO2, PaCO2 and SaO2 levels. None of the patients died from hepatic and renal complications. Pulmonary fibrosis was the most severe complication and the primary cause of death. CONCLUSIONS Paraquat poisoning is difficult to cure. In this study, pulmonary fibrosis was the primary cause of death. Treatment by administering large doses of glucocorticoids and Gamma globulin proved to be effective in the early stage. However, the treatment may not reverse the development of pulmonary fibrosis. The long-term prognosis of paraquat poisoning was not optimistic. The plasma paraquat level could be a significant factor in predicting the prognosis.
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Garcia-Febrero R, Salvador JP, Sanchez-Baeza F, Marco MP. Rapid method based on immunoassay for determination of paraquat residues in wheat, barley and potato. Food Control 2014. [DOI: 10.1016/j.foodcont.2014.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yu G, Kan B, Jian X, Wang J, Sun J, Song C. A case report of acute severe paraquat poisoning and long-term follow-up. Exp Ther Med 2014; 8:233-236. [PMID: 24944627 PMCID: PMC4061211 DOI: 10.3892/etm.2014.1727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/09/2014] [Indexed: 12/21/2022] Open
Abstract
In the present study, the successful management of severe paraquat (PQ) poisoning with multiple organ dysfunction syndrome is described. A 42-year-old female ingested >100 ml PQ (20% weight/volume) in an attempted suicide. After 22 h the patient was admitted to hospital with serious liver, kidney and lung damage. Comprehensive therapy that maximized poison elimination was administered, along with appropriate glucocorticoids and medication for anticoagulation and protection of the liver and kidney. The patient was successfully treated and recovered after 40 days. However, pulmonary damage was aggravated when the glucocorticoid treatment was stopped after 2 months; the lungs recovered again following systematic therapy. Subsequent to a 8-month follow-up, the patient was able to look after herself in her daily life. To the best of our knowledge, successful treatment following severe PQ poisoning is rare.
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Affiliation(s)
- Guangcai Yu
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Baotian Kan
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jieru Wang
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jing Sun
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chengzhen Song
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Liu SH, Lin JL, Shen HL, Chang CC, Huang WH, Weng CH, Hsu CW, Wang IK, Liang CC, Yen TH. Acute large-dose exposure to organophosphates in patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus. Environ Health 2014; 13:11. [PMID: 24597539 PMCID: PMC3975839 DOI: 10.1186/1476-069x-13-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/28/2014] [Indexed: 05/12/2023]
Abstract
BACKGROUND We investigated the mortality rates of patients with and without diabetes mellitus after acute large-dose exposure to organophosphate insecticides. All patients without diabetes mellitus were traced to examine the long-term risk of new-onset diabetes mellitus. Previous reports indicated that organophosphate exposure might increase the risk of new-onset diabetes mellitus. METHODS We analyzed the records of 118 patients referred to Chang Gung Memorial Hospital for management of intentional organophosphate poisoning between 2000 and 2011. Patients were stratified by diabetes mellitus status. Demographic, clinical, laboratory and mortality data were analyzed. RESULTS Most patients were middle aged (53.45 ± 16.20 years) and male (65.3%) and were referred to our hospital after a relatively short amount of time had elapsed since poisoning (median 3.0 hours). 18 (15.2%) of 118 patients died, including 15 (13.8%) of 109 patients without diabetes mellitus and 3 (33.3%) of 9 with diabetes mellitus. There was no significant difference in mortality between these groups (P = 0.117). In a multivariate Cox regression model, hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and corrected QT interval prolongation (P = 0.002) were significant risk factors for mortality. Conversely, diabetes mellitus status was not a significant variable in this model. At routine outpatient follow up a median of 1.25 months post exposure, random blood glucose measurements gave no evidence of new-onset diabetes in patients without pre-existing diabetes. CONCLUSIONS Diabetes mellitus status might not increase mortality risk following acute large-dose exposure to organophosphates, and the risk of new-onset diabetes mellitus also might be minimal in the short term. Larger prospective studies with formal testing for diabetes at later times post-exposure are required.
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Affiliation(s)
- Shou-Hsuan Liu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Hsin-Lan Shen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chih-Chia Liang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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Hou YC, Lin JL, Huang WH, Weng CH, Lee SY, Hsu CW, Wang IK, Liang CC, Chang CT, Lin WR, Yen TH. Outcomes of patients with acetaminophen-associated toxic hepatitis at a far east poison center. SPRINGERPLUS 2013; 2:674. [PMID: 24386620 PMCID: PMC3870054 DOI: 10.1186/2193-1801-2-674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 12/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is an overall paucity of data regarding the outcomes of patients with acetaminophen-associated toxic hepatitis in Taiwan. Therefore, the purpose of this study was to recruit a larger number of patients and to examine the clinical features, the degrees of toxic hepatitis, the physiological markers, and the clinical outcomes after intentional acetaminophen poisoning, and to determine what association, if any, might exist between these findings. METHODS We examined the medical records of 187 patients with intentional acetaminophen poisoning who were examined at Chang Gung Memorial Hospital between 2000 and 2011. Patients were categorized into 2 groups according to hepatic complications, i.e. with (n = 15) or without (n = 172) toxic hepatitis. Demographic, clinical, and laboratory data were collected, and the mortality rate was analyzed. RESULTS It was found that patients with toxic hepatitis had higher serum acetaminophen level (P = 0.007), but they also arrived to the hospital later (P < 0.001) than patients without toxic hepatitis. Furthermore, patients with toxic hepatitis showed higher incidences of acute respiratory failure (P = 0.012) than those shown by patients who did not have hepatitis. The laboratory examinations also revealed greater degrees of granulocytosis (P < 0.001) and poorer liver function tests (P < 0.001) in patients with hepatitis than in patients without hepatitis. Nevertheless, a univariate logistic regression model failed to identify any significant risk factors for toxic hepatitis complication after ingestion (P > 0.05). At the end of the analysis, 1 patient with toxic hepatitis died of liver failure. Finally, there was no significant difference in mortality between patients with and without hepatitis (P = 0.080). CONCLUSION The analytical data revealed that toxic hepatitis was not uncommon (15/187 or 8.0%) after acetaminophen overdose. Further studies are warranted.
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Affiliation(s)
- Yi-Chou Hou
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Shen-Yang Lee
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chih-Chia Liang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan ; Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, 105 Taiwan
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Weng CH, Hu CC, Lin JL, Lin-Tan DT, Hsu CW, Yen TH. Predictors of acute respiratory distress syndrome in patients with paraquat intoxication. PLoS One 2013; 8:e82695. [PMID: 24349340 PMCID: PMC3859634 DOI: 10.1371/journal.pone.0082695] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/03/2013] [Indexed: 12/18/2022] Open
Abstract
Introduction Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters. Materials and Methods In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed. Results The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN48-h scores (P<0.009), SOFA48-h scores (P<0.001), and time to ARDS/nadir PaO2 (P=0.008) but also suffered from lower nadir PaO2 (P<0.001), nadir AaDO2 (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA48-h scores <3 and SOFA48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS. Conclusions The analytical results indicate that SOFA48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Chih Hu
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail:
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Yu HY, Lin JL, Fu JF, Lin JH, Liu SH, Weng CH, Huang WH, Chen KH, Hsu CW, Yen TH. Outcomes of patients with rodenticide poisoning at a far east poison center. SPRINGERPLUS 2013; 2:505. [PMID: 24130963 PMCID: PMC3795205 DOI: 10.1186/2193-1801-2-505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rodenticide poisoning remains a major public health problem in Asian countries. Nevertheless, very few data are available in world literature regarding the outcomes of these patients. Therefore, the purpose of this study was to investigate the clinical outcomes of rodenticide poisonings in our hospital and to compare these data with published reports from other international poison centers. FINDINGS We retrospectively examined the records of 20 patients with rodenticide poisoning (8 brodifacoum, 12 bromadiolone) who were referred to Chang Gung Memorial Hospital between 2000 and 2011. It was found that most of the rodenticide patients were middle-aged adults. Both genders were equally affected and many patients had a past history of major depressive disorder or schizophrenia. Nevertheless, patients with bromadiolone were referred significantly sooner than patients with brodifacoum poisoning (0.1 ± 0.1 versus 5.5 ± 10.5, P < 0.001). Furthermore, it was found that patients with brodifacoum suffered higher incidences of ecchymosis (50.0% versus 0%, P = 0.006) and hematuria (50.0% versus 0%, P = 0.006) than patients with bromadiolone poisoning. Laboratory analysis also demonstrated a poorer hemostatic profile of patients with brodifacoum [prothrombin time (PT), international normalized ratio (INR), 4.3 ± 4.8 versus 1.0 ± 0.1, P = 0.032; PT prolongation, 50.0% versus 0%, P = 0.006; activated partial thromboplastin time (aPTT) prolongation, 50.0% versus 0%, P = 0.006] than patients with bromadiolone poisoning. At the end of analysis, no patient died of the poisoning. CONCLUSION The favorable outcome (zero mortality rate) is comparable to the published reports from other international poison centers. Further studies are warranted.
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Affiliation(s)
- Hsin-Ying Yu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, 105 Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen HH, Lin JL, Huang WH, Weng CH, Lee SY, Hsu CW, Chen KH, Wang IK, Liang CC, Chang CT, Yen TH. Spectrum of corrosive esophageal injury after intentional paraquat or glyphosate-surfactant herbicide ingestion. Int J Gen Med 2013; 6:677-83. [PMID: 23983484 PMCID: PMC3747816 DOI: 10.2147/ijgm.s48273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Data on the spectrum of corrosive injury to the esophagus after paraquat or glyphosate-surfactant ingestion are sparse in the literature and confined to case studies and brief reports. Therefore, this study aimed to examine the clinical features, degrees of esophageal injury, and clinical outcomes after paraquat or glyphosate herbicide ingestion, and sought to determine what association, if any, may exist between these findings. METHODS We performed an observational study on 47 patients with paraquat or glyphosate ingestion who underwent endoscopic evaluation over a period of 11 years (2000-2011). RESULTS Corrosive esophageal injuries were classified as grade 1 in 14 (glyphosate-surfactant) and three (paraquat), grade 2a in nine (glyphosate-surfactant) and 18 (paraquat), and grade 2b in one (glyphosate-surfactant) and two (paraquat) patients. No patients had grade 0, 3a, or 3b esophageal injuries. Therefore, the severity of corrosive injury was more severe in the paraquat group (P = 0.005). After toxin ingestion, systemic toxicity occurred, with rapid development of systemic complications in many cases. Neurologic complications occurred more frequently in the glyphosate-surfactant group (29.2% versus 0%, P = 0.005), although respiratory failure (4.2% versus 34.8%, P = 0.008), hepatitis (12.5% versus 52.2%, P = 0.004), and renal failure (20.8% versus 52.2%, P = 0.025) developed more frequently in the paraquat group. Patients with glyphosate poisoning had shorter hospital stays than patients with paraquat poisoning (13.3 ± 15.1 days versus 26.8 ± 10.2 days, P = 0.001). Nevertheless, there was no significant difference in mortality rate between the glyphosate-surfactant and paraquat groups (8.3% versus 13.0%, P = 0.601). We ultimately found that patients with grade 2b esophageal injury suffered from a greater incidence of respiratory (100.0% versus 5.9%, P = 0.001) and gastrointestinal (66.7% versus 11.8%, P = 0.034) complications than patients with grade 1 injury, regardless of herbicide type. CONCLUSION Paraquat and glyphosate are mild caustic agents that produce esophageal injuries of grades 1, 2a, and 2b only. Our data also suggest a potential relationship between the degree of esophageal injury and systemic complications.
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Affiliation(s)
- Hsiao-Hui Chen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
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An electrochemical magneto immunosensor (EMIS) for the determination of paraquat residues in potato samples. Anal Bioanal Chem 2013; 405:7841-9. [PMID: 23887278 DOI: 10.1007/s00216-013-7209-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/17/2013] [Accepted: 07/02/2013] [Indexed: 01/04/2023]
Abstract
An electrochemical magneto immunosensor for the detection of low concentrations of paraquat (PQ) in food samples has been developed and its performance evaluated in a complex sample such as potato extracts. The immunosensor presented uses immunoreagents specifically developed for the recognition of paraquat, a magnetic graphite-epoxy composite (m-GEC) electrode and biofunctionalized magnetic micro-particles (PQ1-BSAMP) that allow reduction of the potential interferences caused by the matrix components. The amperometric signal is provided by an enzymatic probe prepared by covalently linking an enzyme to the specific antibodies (Ab198-cc-HRP). The use of hydroquinone, as mediator, allows recording of the signal at a low potential, which also contributes to reducing the background noise potentially caused by the sample matrix. The immunocomplexes formed on top of the modified MP are easily captured by the m-GEC, which acts simultaneously as transducer. PQ can be detected at concentrations as low as 0.18 ± 0.09 μg L(-1). Combined with an efficient extraction procedure, PQ residues can be directly detected and accurately quantified in potato extracts without additional clean-up or purification steps, with a limit of detection (90% of the maximum signal) of 2.18 ± 2.08 μg kg(-1), far below the maximum residue level (20 μg kg(-1)) established by the EC. The immunosensor presented here is suitable for on-site analysis. Combined with the use of magnetic racks, multiple samples can be run simultaneously in a reasonable time.
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Lee CH, Hsieh SY, Lin JL, Liu MS, Yen TH. Hepatocellular carcinoma in patients with chronic kidney disease. World J Gastroenterol 2013; 19:2466-2472. [PMID: 23674847 PMCID: PMC3646136 DOI: 10.3748/wjg.v19.i16.2466] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/25/2012] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate outcomes of hepatocellular carcinomas (HCCs) in patients with chronic kidney disease (CKD).
METHODS: Four hundred and forty patients referred between 2000 and 2002 for management of HCCs were categorized according to their CKD stage, i.e., estimated glomerular filtration rate (eGFR) > 90 (stage 1), 60-90 (stage 2), 30-60 (stage 3), 15-30 (stage 4), and < 15 (stage 5) mL/min per 1.73 m2, respectively. Demographic, clinical and laboratory data were collected and mortality rates and cause of mortality were analyzed. The mortality data were examined with Kaplan-meier method and the significance was tested using a log-rank test. An initial univariate Cox regression analysis was performed to compare the frequency of possible risk factors associated with mortality. To control for possible confounding factors, a multivariate Cox regression analysis (stepwise backward approach) was performed to analyze those factors that were significant in univariate models (P < 0.05) and met the assumptions of a proportional hazard model.
RESULTS: Most HCC patients with CKD were elderly, with mean age of diagnosis of 60.6 ± 11.9 years, and mostly male (74.8%). Hepatitis B, C and B and C co-infection virus were positive in 61.6%, 45.7% and 14.1% of the patients, respectively. It was found that patients with stages 4 and 5 CKD were not only older (P = 0.001), but also had higher hepatitis C virus carrier rate (P = 0.001), lower serum albumin level (P = 0.001), lower platelet count (P = 0.037), longer prothrombin time (P = 0.001) as well as higher proportions of advanced cirrhosis (P = 0.002) and HCCs (P = 0.001) than patients with stages 1 and 2 CKD. At the end of analysis, 162 (36.9%) patients had died. Kaplan-Meier analysis revealed that patients with stages 4 and 5 CKD suffered lower cumulative survival than stages 1 and 2 CKD (log-rank test, χ2 = 11.764, P = 0.003). In a multivariate Cox-regression model, it was confirmed that CKD stage [odds ratio (OR) = 1.988, 95%CI: 1.012-3.906, P = 0.046)], liver cirrhosis stage (OR = 3.571, 95%CI: 1.590-8.000, P = 0.002) and serum albumin level (OR = 0.657, 95%CI: 0.491-0.878, P = 0.005) were significant predictors for mortality in this population.
CONCLUSION: HCC patients with stages 4 and 5 CKD had inferior survival than stages 1 and 2 CKD. This warrants further studies.
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Abstract
OBJECTIVE This observational study examined the outcome of Taiwanese pediatric patients with paraquat poisoning and compared these data with the published data on paraquat poisonings from other international poisoning centers. METHODS We performed a retrospective study on children with acute paraquat poisoning that were admitted to the Chang Gung Memorial Hospital during a period of 10 years (2000-2010). Of the 193 paraquat poisoning patients, only 6 were children. RESULTS The mean age was 8.85 ± 5.55 (1-15.6) years. Younger patients had accidentally swallowed paraquat, whereas older patients had intentionally ingested paraquat. Most patients were referred within a relatively short period (0.5-2.0 hours). Paraquat poisoning was associated with high morbidity and often resulted in severe complications, including acute respiratory distress syndrome and multiple-organ failure. The complications included shock (50.0%), hypoxemia (33.3%), respiratory failure (33.3%), nausea/vomiting (16.7%), abdominal pain (33.3%), hepatitis (66.7%), gastrointestinal tract bleeding (33.3%), acute renal failure (33.3%), and seizures (16.7%). Patients were treated aggressively with a standard detoxification protocol consisting of gastric lavage, active charcoal, charcoal hemoperfusion, and cyclophosphamide and steroid pulse therapies. Secondary bacterial infections were common after hospitalization and included sepsis (33.3%), pneumonia (33.3%), and urinary tract infection (50.0%). In the end, 2 patients (33.3%) died from multiple-organ failure, despite intensive resuscitation. CONCLUSIONS Our data (mortality rate, 33.3%) are comparable to the data of other published reports from other international poison centers. Evidently, a prompt diagnosis of paraquat poisoning and an immediate institution of a detoxification protocol is a prerequisite for a favorable outcome.
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Connors NJ, Biary R, Hoffman RS. Comments on 'Spectrum of toxic hepatitis following intentional paraquat ingestion'. Liver Int 2013; 33:494. [PMID: 23402615 DOI: 10.1111/liv.12087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/01/2012] [Indexed: 02/13/2023]
Affiliation(s)
- Nicholas J. Connors
- NYU/Bellevue Medical Center, New York City Posion Control Center; New York US
| | - Rana Biary
- NYU/Bellevue Medical Center, New York City Posion Control Center; New York US
| | - Robert S. Hoffman
- NYU/Bellevue Medical Center, New York City Posion Control Center; New York US
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Weng CH, Hu CC, Lin JL, Lin-Tan DT, Huang WH, Hsu CW, Yen TH. Sequential organ failure assessment score can predict mortality in patients with paraquat intoxication. PLoS One 2012; 7:e51743. [PMID: 23272154 PMCID: PMC3522704 DOI: 10.1371/journal.pone.0051743] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/05/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction Paraquat poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. The objective of this study was to identify predictors of mortality in cases of paraquat poisoning. Furthermore, we sought to determine the association between these parameters. Methods A total of 187 patients were referred for management of intentional paraquat ingestion between January 2000 and December 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and acute kidney injury network (AKIN) scores were collected, and predictors of mortality were analyzed. Results Overall hospital mortality for the entire population was 54% (101/187). Using a multivariate logistic regression model, it was found that age, time to hospitalization, blood paraquat level, estimated glomerular filtration rate at admission (eGFR first day), and the SOFA48-h score, but not the AKIN48-h score, were significant predictors of mortality. For predicting the in-hospital mortality, SOFA48-h scores displayed a good area under the receiver operating characteristic curve (AUROC) (0.795±0.033, P<0.001). The cumulative survival rate differed significantly between patients with SOFA48-h scores <3 and those ≥3 (P<0.001). A modified SOFA (mSOFA) score was further developed by using the blood paraquat level, and this new score also demonstrated a better AUROC (0.848±0.029, P<0.001) than the original SOFA score. Finally, the cumulative survival rate also differed significantly between patients with mSOFA scores <4 and ≥4 (P<0.001). Conclusion The analytical data demonstrate that SOFA and mSOFA scores, which are based on the extent of organ function or rate of organ failure, help to predict mortality after intentional paraquat poisoning.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail:
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