Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)

Management of Paraquat Poisoning-The Way Forward

How to cite this article: Ahmed A, Prasad A, Bhattacharjee A. Management of Paraquat Poisoning-The Way Forward. Indian J Crit Care Med 2024;28(8):722-723.

Inhibitory effect of pirfenidone on pulmonary fibrosis in patients with acute paraquat poisoning

OBJECTIVE

To study the efficacy of pirfenidone (PFD) on patients with pulmonary fibrosis caused by acute paraquat (PQ) poisoning.

METHODS

A total of 86 patients with pulmonary fibrosis caused by acute PQ poisoning admitted to our hospital were analyzed retrospectively. All of them successfully received the standard 21-day treatment based on "Taishan Consensus", and they were assigned to the PFD group or the NO-PFD group according to whether they received PFD treatment (at 200 mg/time, 3 times/day) for 6 months after discharge. The two groups were compared in effective treatment rate, mortality and incidence of adverse reactions such as liver and kidney function damage, pulmonary fibrosis-associated indexes, pulmonary function-associated indexes, and arterial blood gas indexes before and after therapy.

RESULTS

The PFD group showed a notably higher effective treatment rate than the NO-PFD group (P<0.05). Additionally, the PFD group showed notably lower levels of serum hyaluronic acid (HA), laminin (LN), type IV collagen (CIV), and type III procollagen (PCIII), and notably higher levels of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC than the NO-PFD group (all P<0.001), and the PFD group also showed significantly higher levels of arterial blood gas indexes including arterial partial pressure of oxygen (PaO2) and PaO2/inspired oxygen (FIO2) than the NO-PFD group (both P<0.001). Moreover, the Kaplan-Meier survival curves showed that the survival rate of the patients in PFD group was significantly higher than that in the NO-PFD group (P<0.05).

CONCLUSION

With a high safety, PFD can effectively improve the treatment efficacy in patients with pulmonary fibrosis caused by acute PQ poisoning. PFD can improve the pulmonary function and arterial blood gas status of patients, without causing obvious liver and kidney damage.

Use of low-molecular-weight heparin in severe paraquat poisoning: a case report

BACKGROUND

Acute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning.

CASE PRESENTATION

After ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days.

CONCLUSIONS

Although the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.

Combined signaling of NF-kappaB and IL-17 contributes to Mesenchymal stem cells-mediated protection for Paraquat-induced acute lung injury

BACKGROUND

Paraquat (PQ) is an herbicide widely used in the world. PQ can cause pulmonary toxicity and even acute lung injury. Treatment for PQ poisoning in a timely manner is still a challenge for clinicians. Mesenchymal stem cell (MSC) transplantation has hold potentials for the treatment of several lung diseases including PQ poisoning. The aim of this study is to examine the mechanisms mediated by MSC transplantation to protect PQ-induced lung injury.

METHODS

Here we performed the whole genome sequencing and compared the genes and pathways in the lung that were altered by PQ or PQ together with MSC treatment.

RESULTS

The comparison in transcriptome identified a combined mitigation in NF-kappaB signaling and IL-17 signaling in MSC transplanted samples.

CONCLUSION

This study not only reiterates the important role of NF-kappaB signaling and IL-17 signaling in the pathogenesis of PQ-induced toxicity, but also provides insight into a molecular basis of MSC administration for the treatment of PQ-induced toxicity.

Where ferroptosis inhibitors and paraquat detoxification mechanisms intersect, exploring possible treatment strategies

Paraquat (PQ) is a fast-acting and effective herbicide that is used throughout the world to eliminate weeds. Over the past years, PQ was considered one of the most popular poisoning substances for suicide, and PQ poisoning accounts for about one-third of suicides around the world. Poisoning with PQ may cause multiorgan failure, pulmonary fibrosis, and ultimately death. Exposure to PQ results in the accumulation of PQ in the lungs, causing severe damage and, eventually, fibrosis. Until now, no effective antidote has been found to treat poisoning with PQ. In general, the toxicity of PQ is due to the formation of high energy oxygen free radicals and the peroxidation of unsaturated lipids in the cell. Ferroptosis is the result of the loss of glutathione peroxidase 4 (GPX4) activity that transforms iron-dependent lipid hydroperoxides to lipid alcohols, which are inert in the biological environment. Impaired iron metabolism and lipid peroxidation are increasingly known as the driving agents of ferroptosis. The contribution of ferroptosis to the development of cell death during poisoning with PQ has not yet been addressed. There is growing evidence about the relationship between PQ poisoning and ferroptosis. This raises the possibility of using ferroptosis inhibitors for the treatment of PQ poisoning. In this hypothesis-driven review article, we elaborated how ferroptosis inhibitors might circumvent the toxicity induced by PQ and may be potentially useful for the treatment of PQ toxicity.

Extracorporeal treatment in children with acute severe poisoning

Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons.We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded.The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died.ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.