Inhibition of the absorption of paraquat from the gastrointestinal tract by adsorbents

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model

BACKGROUND

Gastric lavage (GL) is one of the most critical early therapies for acute paraquat (PQ) poisoning; however, details of the treatment protocol remain to be established.

METHODS

A rapid quantitative method involving sodium dithionite testing was developed. It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL, or without. The vital signs, laboratory testing, and PQ plasma concentrations were collected for therapeutic effect evaluation.

RESULTS

The reaction conditions of the test were optimized for two types of samples. Early GL at one hour (H1) could improve the signs and symptoms after acute PQ poisoning at 24 hours (H24). In contrast, GL at 6 hours (H6) could only partially relieve the vital signs. The H1 GL group effectively reduced the peak of the plasma PQ concentration. In addition, the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24. Moreover, there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups. However, the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.

CONCLUSION

GL only at early stage may it benefit PQ poisoning in an animal model. The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate. The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

Activated charcoal is as effective as fuller's earth or bentonite in paraquat poisoning

In vitro investigations have shown that the adsorption capacity of activated charcoal ('Kohle-Compretten', 'Ultracarbon', E. Merck, Darmstadt, FRG) is just as high as that of 'Fuller's earth' (Surrey powder, Laporte Industries Ltd., Luton, GB) or 'Bentonite BP W.B. (Steetley Minerals Ltd., Milton Keynes, GB). Fuller's earth ('Fullererde') from another manufacturer has had very poor adsorption properties and is thus not suitable for the treatment of paraquat poisoning. Animal experiments have shown that the curative effect of activated charcoal given 0.5, 1, 2, and 3 h after ingestion of 200 and 300 mg paraquat/kg body weight is equally as good or even better than that of 'Fuller's earth' or 'Bentonite BP W.B' Activated charcoal is a substitute of equal value to these mineral soils.

Effective treatment for paraquat poisoning in rats and its relevance to treatment of paraquat poisoning in man

After oral administration of a lethal dose of paraquat to rats the plasma concentration remained relatively constant over four to 30 hours and was related to the paraquat content of the small intestine over the first 16 hours. During the first 30 hours the concentration of paraquat in the lung rose progressively above that of the plasma to levels which are known to cause pulmonary damage. A treatment has been devised which prevents the absorption of paraquat into the plasma and prevents accumulation of paraquat in the lung. This treatment consists of a stomach was followed by four administrations of bentonite plus purgatives at two- to three-hour intervals. Even when treatment was delayed until 10 hours after administration of paraquat 80% survival was obtained. The relevance of this treatment to paraquat poisoning in man is discussed in the light of the finding that slices of human lung accumulate paraquat in the same way as those of rat lung.